Provider Demographics
NPI:1891020806
Name:HOLM, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HOLM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NE EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1427
Mailing Address - Country:US
Mailing Address - Phone:541-936-9456
Mailing Address - Fax:541-479-1613
Practice Address - Street 1:124 NE EVELYN AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1427
Practice Address - Country:US
Practice Address - Phone:541-936-9456
Practice Address - Fax:541-479-1613
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11043122300000X
AZ7884122300000X
CO10249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist