Provider Demographics
NPI:1487861902
Name:HOLCOMB, JOHN Q (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Q
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 7TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1614
Mailing Address - Country:US
Mailing Address - Phone:310-393-9733
Mailing Address - Fax:310-573-1383
Practice Address - Street 1:1234 7TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1614
Practice Address - Country:US
Practice Address - Phone:310-393-9733
Practice Address - Fax:310-573-1383
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADE0287181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics