Provider Demographics
NPI:1508274515
Name:HOLMES, DENNIS (LAC #AC00002)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LAC #AC00002
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 HIGHWAY 25
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7105
Mailing Address - Country:US
Mailing Address - Phone:601-884-1000
Mailing Address - Fax:601-884-1005
Practice Address - Street 1:5719 HIGHWAY 25
Practice Address - Street 2:SUITE 1
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7105
Practice Address - Country:US
Practice Address - Phone:601-884-1000
Practice Address - Fax:601-884-1005
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAC00002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist