Provider Demographics
NPI:1699727388
Name:J. GREG HOLM D.D.S.,P.A.
Entity type:Organization
Organization Name:J. GREG HOLM D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEHMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-722-3191
Mailing Address - Street 1:7405 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3514
Mailing Address - Country:US
Mailing Address - Phone:316-722-3191
Mailing Address - Fax:316-722-7824
Practice Address - Street 1:7405 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3514
Practice Address - Country:US
Practice Address - Phone:316-722-3191
Practice Address - Fax:316-722-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS63781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1467451633OtherINDIVIDUAL NPI NUMBER
KS1336128990OtherDR. GUST IND NPI NUMBER
KS421771OtherGROUP BC NUMBER
KS60340OtherDR GUST LIC NUMBER
KS6378OtherDENTAL LIC NUMBER
KS116941OtherBC PROVIDER NUMBER
KS116942OtherDR. GUST BC NUMBER
KS116941OtherBC PROVIDER NUMBER
KS116942OtherDR. GUST BC NUMBER