Provider Demographics
NPI:1649309634
Name:HOLDER, RAY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:
Last Name:HOLDER
Suffix:JR
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 1:2500 N STATE ST
Mailing Address - Street 2:SCHOOL OF DENTISTRY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-985-6028
Mailing Address - Fax:601-984-6039
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:SCHOOL OF DENTISTRY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-985-6028
Practice Address - Fax:601-984-6039
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2413-88122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist