Individual
DR. BRENT L HOLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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
BLUE CROSS BLUE SHIELD
ND
01
—
330
DELTA DENTAL
MN
05
—
370720200
—
MN
05
—
40633
—
ND
01
—
91799110
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/17/2006
Last updated
05/01/2014
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