Provider Demographics
NPI:1386745974
Name:HOLMES, RYAN K (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9181
Mailing Address - Country:US
Mailing Address - Phone:260-469-3671
Mailing Address - Fax:260-469-3672
Practice Address - Street 1:10435 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9181
Practice Address - Country:US
Practice Address - Phone:260-469-3671
Practice Address - Fax:260-469-3672
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10552A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice