Provider Demographics
NPI:1588395966
Name:HOLMES, DEXTER DELMAR
Entity type:Individual
Prefix:MR
First Name:DEXTER
Middle Name:DELMAR
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 STERLING VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4671
Mailing Address - Country:US
Mailing Address - Phone:702-980-5419
Mailing Address - Fax:
Practice Address - Street 1:510 INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1007
Practice Address - Country:US
Practice Address - Phone:702-980-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician