Provider Demographics
NPI:1639502396
Name:HOLMES, SPENCER FREDERICK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:FREDERICK
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LONSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3143
Mailing Address - Country:US
Mailing Address - Phone:423-802-1381
Mailing Address - Fax:
Practice Address - Street 1:3286 PENTAGON PARK BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:423-802-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022535122300000X
MADL13207122300000X
TX294171223E0200X
OH30.0268091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist