Provider Demographics
NPI:1427111566
Name:KENNETH A HOLMAN DDS INC
Entity type:Organization
Organization Name:KENNETH A HOLMAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-366-5758
Mailing Address - Street 1:52 ARCH ST
Mailing Address - Street 2:#2
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062
Mailing Address - Country:US
Mailing Address - Phone:650-366-5758
Mailing Address - Fax:650-366-0714
Practice Address - Street 1:52 ARCH ST
Practice Address - Street 2:#2
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-366-5758
Practice Address - Fax:650-366-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty