1518406453 NPI number — DDMDMD DENTAL ASSOC

Table of content: BETTINA MARIE HOLMES MSW (NPI 1700613759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518406453 NPI number — DDMDMD DENTAL ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DDMDMD DENTAL ASSOC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518406453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 WEXFORD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02494-2912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-449-0477
Provider Business Mailing Address Fax Number:
781-400-5130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 WEXFORD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02494-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-449-0477
Provider Business Practice Location Address Fax Number:
781-400-5130
Provider Enumeration Date:
02/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAINES
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
781-893-7500

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)