Basic Information
| Provider Information | |||||||||
| NPI: | 1982867024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARIF-HOLMES | ||||||||
| FirstName: | LAKISHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5019 W NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532081121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144456500 | ||||||||
| FaxNumber: | 4144456618 | ||||||||
| Practice Location | |||||||||
| Address1: | 5019 W NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532081121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144456500 | ||||||||
| FaxNumber: | 4144456618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 08/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6448-15 | WI | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1982867024 | 05 | WI | MEDICAID |