Provider Demographics
NPI:1841273737
Name:AITA-HOLMES, CYNTHIA M (DMD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:AITA-HOLMES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GAFFNEY #7500
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7500
Mailing Address - Country:US
Mailing Address - Phone:907-353-4114
Mailing Address - Fax:907-353-4852
Practice Address - Street 1:1060 GAFFNEY #7500
Practice Address - Street 2:
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7500
Practice Address - Country:US
Practice Address - Phone:907-353-4114
Practice Address - Fax:907-353-4852
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0527131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN