Provider Demographics
NPI:1427377175
Name:M J HOLMES DENTAL OFFICE INC
Entity Type:Organization
Organization Name:M J HOLMES DENTAL OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINER
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-548-3384
Mailing Address - Street 1:9815 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5702
Mailing Address - Country:US
Mailing Address - Phone:281-548-3384
Mailing Address - Fax:281-548-7336
Practice Address - Street 1:9815 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5702
Practice Address - Country:US
Practice Address - Phone:281-548-3384
Practice Address - Fax:281-548-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137228609Medicaid