Provider Demographics
NPI:1689716599
Name:RICHARD M HOLMES DMD, PA
Entity Type:Organization
Organization Name:RICHARD M HOLMES DMD, PA
Other - Org Name:INDIAN TRAIL DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PA
Authorized Official - Phone:704-821-7222
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-0338
Mailing Address - Country:US
Mailing Address - Phone:704-821-7222
Mailing Address - Fax:704-821-4310
Practice Address - Street 1:136 INDIAN TRAIL RD S
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9669
Practice Address - Country:US
Practice Address - Phone:704-821-7222
Practice Address - Fax:704-821-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC60391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty