Provider Demographics
NPI:1992125306
Name:CHARLES O. HOLMES DDS PS
Entity type:Organization
Organization Name:CHARLES O. HOLMES DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-575-4840
Mailing Address - Street 1:22030 7TH AVE S
Mailing Address - Street 2:STE 105
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6219
Mailing Address - Country:US
Mailing Address - Phone:206-575-4840
Mailing Address - Fax:206-878-2919
Practice Address - Street 1:22030 7TH AVE S
Practice Address - Street 2:STE 105
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6219
Practice Address - Country:US
Practice Address - Phone:206-575-4840
Practice Address - Fax:206-878-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty