Individual
J GREG HOLM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S., P.A.
Contact information
Practice address
7405 W CENTRAL AVE, WICHITA, KS 67212-3514
(316) 722-3191
(316) 722-7827
Mailing address
7405 W CENTRAL AVE, WICHITA, KS 67212-3514
(316) 722-3191
(316) 722-7827
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6378
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22817
BLUE CROSS PROVIDER #
KS
Enumeration date
07/19/2005
Last updated
07/08/2007
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