Provider Demographics
NPI:1851096515
Name:HOLSWORTH, DEAN
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:HOLSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-0247
Mailing Address - Country:US
Mailing Address - Phone:989-423-8907
Mailing Address - Fax:
Practice Address - Street 1:2770 E ASHBY RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8979
Practice Address - Country:US
Practice Address - Phone:989-423-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health