Provider Demographics
NPI:1124115134
Name:HOLMAN, JOHN KEVIN (DMD MSD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEVIN
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0526
Mailing Address - Country:US
Mailing Address - Phone:662-842-1735
Mailing Address - Fax:662-842-1769
Practice Address - Street 1:99 PARK GATE DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3006
Practice Address - Country:US
Practice Address - Phone:662-842-1735
Practice Address - Fax:662-842-1769
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR290951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics