Provider Demographics
NPI:1689089096
Name:HOLM, RACHEL KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:KATHERINE
Last Name:HOLM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KATHERINE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3939 W 50TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1244
Mailing Address - Country:US
Mailing Address - Phone:952-922-5561
Mailing Address - Fax:
Practice Address - Street 1:3939 W 50TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1244
Practice Address - Country:US
Practice Address - Phone:952-922-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND134101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice