Provider Demographics
NPI:1790854032
Name:HOLST, LISA KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KIM
Last Name:HOLST
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 1:401 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2004
Mailing Address - Country:US
Mailing Address - Phone:641-828-8778
Mailing Address - Fax:641-828-9058
Practice Address - Street 1:401 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2004
Practice Address - Country:US
Practice Address - Phone:641-828-8778
Practice Address - Fax:641-828-9058
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA73801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice