Provider Demographics
NPI:1609169762
Name:HOLDER, ADAM MICHAEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MICHAEL
Last Name:HOLDER
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 1:220 3RD ST. W
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-4556
Mailing Address - Country:US
Mailing Address - Phone:218-839-0873
Mailing Address - Fax:
Practice Address - Street 1:302 FIRE MONUMENT RD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:MN
Practice Address - Zip Code:55037-8350
Practice Address - Country:US
Practice Address - Phone:320-384-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist