Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 101685 | TX |
NPI | 1083111959 |
---|---|
Provider Name | Jessica Michelle Holmes |
First Address | El Paso, TX 79934-3342 |
Second Address | El Paso, TX 79934-3342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 09/04/2018 |