Provider Demographics
NPI:1780953356
Name:HOLMES, DANA M (LAC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RIVER DELL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2302
Mailing Address - Country:US
Mailing Address - Phone:845-490-0936
Mailing Address - Fax:
Practice Address - Street 1:140 MORRIS ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4274
Practice Address - Country:US
Practice Address - Phone:845-490-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00077700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist