Provider Demographics
NPI:1861000879
Name:HOLMES, DEVEN JERRE (DMD)
Entity Type:Individual
Prefix:
First Name:DEVEN
Middle Name:JERRE
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 ATLAS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3114
Mailing Address - Country:US
Mailing Address - Phone:608-222-8344
Mailing Address - Fax:
Practice Address - Street 1:826 ATLAS AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-3114
Practice Address - Country:US
Practice Address - Phone:608-222-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10023641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice