1912285123 NPI number — DR. DAVID EARL HOLSEY DDS

Table of content: (NPI 1710904537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912285123 NPI number — DR. DAVID EARL HOLSEY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLSEY
Provider First Name:
DAVID
Provider Middle Name:
EARL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLSEY
Provider Other First Name:
DAVID
Provider Other Middle Name:
EARL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912285123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 LOUISIANA BLVD NE STE D
Provider Second Line Business Mailing Address:
UPTOWN PARK DENTAL PRACTICE, LLC
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-4547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-883-4867
Provider Business Mailing Address Fax Number:
505-883-4007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 LOUISIANA BLVD NE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-883-4867
Provider Business Practice Location Address Fax Number:
505-883-4007
Provider Enumeration Date:
07/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DD3486 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD3486 . This is a "STATE LIC" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com