Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901020424 | MI |
N | 1223P0300X | Periodontist | 7257 | NE |
NPI | 1144500349 |
---|---|
Provider Name | Dr. Peter L Holden |
First Address | Midland, MI 48642-8538 |
Second Address | Midland, MI 48642-8538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2011 |
Last Update Date | 21/09/2021 |