Provider Demographics
NPI:1912285123
Name:HOLSEY, DAVID EARL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:HOLSEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:EARL
Other - Last Name:HOLSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2201 LOUISIANA BLVD NE STE D
Mailing Address - Street 2:UPTOWN PARK DENTAL PRACTICE, LLC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4547
Mailing Address - Country:US
Mailing Address - Phone:505-883-4867
Mailing Address - Fax:505-883-4007
Practice Address - Street 1:2201 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-883-4867
Practice Address - Fax:505-883-4007
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDD3486OtherSTATE LIC