Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 12011377A | IN |
N | 213EG0000X | General Practice | 12011377A | IN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS040766 | PA |
NPI | 1366670184 |
---|---|
Provider Name | Curtis Jermaine Holmes |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes-Barre, PA 18702-3312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 02/09/2016 |