Provider Demographics
NPI:1053400820
Name:HOLMES, SCOTT EUGENE (DMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EUGENE
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PASADENA DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2969
Mailing Address - Country:US
Mailing Address - Phone:859-273-2114
Mailing Address - Fax:859-273-3535
Practice Address - Street 1:185 PASADENA DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2969
Practice Address - Country:US
Practice Address - Phone:859-273-2114
Practice Address - Fax:859-273-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY63401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice