Provider Demographics
NPI:1497739494
Name:HOLMES, JON D (DMD,MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:D
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DMD,MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 19TH ST S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-5628
Mailing Address - Country:US
Mailing Address - Phone:205-933-2773
Mailing Address - Fax:205-933-5147
Practice Address - Street 1:1500 19TH ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-5628
Practice Address - Country:US
Practice Address - Phone:205-933-2773
Practice Address - Fax:205-933-5147
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH10598Medicare UPIN