Provider Demographics
NPI:1144330705
Name:HOLMES, KIMBER LEE (DDS)
Entity type:Individual
Prefix:
First Name:KIMBER
Middle Name:LEE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1942
Mailing Address - Country:US
Mailing Address - Phone:713-946-5171
Mailing Address - Fax:713-946-0047
Practice Address - Street 1:3602 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1942
Practice Address - Country:US
Practice Address - Phone:713-946-5171
Practice Address - Fax:713-946-0047
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169101223G0001X
TX16906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
760519739OtherFEDERAL TAX ID