Provider Demographics
NPI:1063518835
Name:STEVEN J HOLM DDS INC
Entity type:Organization
Organization Name:STEVEN J HOLM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-763-2727
Mailing Address - Street 1:3465 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5107
Mailing Address - Country:US
Mailing Address - Phone:219-763-2727
Mailing Address - Fax:219-763-0126
Practice Address - Street 1:3465 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5107
Practice Address - Country:US
Practice Address - Phone:219-763-2727
Practice Address - Fax:219-763-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty