Provider Demographics
NPI:1528121258
Name:HOLMAN, BRENT L (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:L
Last Name:HOLMAN
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 1:2538 UNIVERSITY DR S
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5737
Mailing Address - Country:US
Mailing Address - Phone:701-232-1148
Mailing Address - Fax:701-232-8907
Practice Address - Street 1:2538 UNIVERSITY DR S
Practice Address - Street 2:SUITE A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5737
Practice Address - Country:US
Practice Address - Phone:701-232-1148
Practice Address - Fax:701-232-8907
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26296OtherBLUE CROSS BLUE SHIELD
MN330OtherDELTA DENTAL
MN91799110OtherBLUE CROSS BLUE SHIELD
MN370720200Medicaid
ND40633Medicaid