Provider Demographics
NPI:1578878856
Name:HOLMES, JESSICA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:R
Last Name:HOLMES
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 1:12413 OLD YATES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2023
Mailing Address - Country:US
Mailing Address - Phone:717-385-6755
Mailing Address - Fax:
Practice Address - Street 1:16708 JEFFERSON DAVIS HWY STE 115
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2770
Practice Address - Country:US
Practice Address - Phone:703-221-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038472122300000X
WV38981223G0001X
VA04014132001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice