Organization
BRENT L HOLMAN DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT L HOLMAN DDS (PRESIDENT)
(701) 232-1148
Entity
Organization
Contact information
Practice address
2538 UNIVERSITY DR S, SUITE A, FARGO, ND 58103-5737
(701) 232-1148
(701) 232-8907
Mailing address
2538 UNIVERSITY DR S, SUITE A, FARGO, ND 58103-5737
(701) 232-1148
(701) 232-8907
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1587
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26296
ND BLUE CROSS BLUE SHIELD
ND
01
—
330
DELTA DENTAL
MN
05
—
40633
—
ND
01
—
91799110
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/17/2006
Last updated
08/22/2020
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