Provider Demographics
NPI:1508965195
Name:HOLM, NANCY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HOLM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 NICOLLET AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5790
Mailing Address - Country:US
Mailing Address - Phone:952-435-3335
Mailing Address - Fax:952-435-1681
Practice Address - Street 1:14000 NICOLLET AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5790
Practice Address - Country:US
Practice Address - Phone:952-435-3335
Practice Address - Fax:952-435-1681
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice