Provider Demographics
NPI:1669644142
Name:PETERING HOLMAN, AMY JOANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:JOANNE
Last Name:PETERING HOLMAN
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 1:4960 CEMETERY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1622
Mailing Address - Country:US
Mailing Address - Phone:614-876-1161
Mailing Address - Fax:
Practice Address - Street 1:4960 CEMETERY RD
Practice Address - Street 2:SUITE A
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1622
Practice Address - Country:US
Practice Address - Phone:614-876-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300208841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice