Provider Demographics
NPI:1144500349
Name:HOLDEN, PETER L (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 POWDER HORN TRL
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8538
Mailing Address - Country:US
Mailing Address - Phone:989-615-3421
Mailing Address - Fax:
Practice Address - Street 1:5704 POWDER HORN TRL
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8538
Practice Address - Country:US
Practice Address - Phone:989-615-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72571223P0300X
MI2901020424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics