Provider Demographics
NPI:1831184100
Name:HOLES, BRUCE E (DMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:HOLES
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 1:22 W ROBERT TOOMBS AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-2107
Mailing Address - Country:US
Mailing Address - Phone:706-678-4321
Mailing Address - Fax:
Practice Address - Street 1:22 W ROBERT TOOMBS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1662
Practice Address - Country:US
Practice Address - Phone:706-678-4300
Practice Address - Fax:706-678-1750
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10,0361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00303025AMedicaid