Basic Information
| Provider Information | |||||||||
| NPI: | 1972593747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY RD STOP 7500 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY, ATTN: CREDENTIALS | ||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073615530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD #7500 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY, ATTN: CREDENTIALS COORDINATOR | ||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073615530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 09/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 051654 | NY | Y | Dental Providers | Dentist | Periodontics |
No ID Information.