Provider Demographics
NPI:1427668300
Name:HOLMES, MORGAN WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:WAYNE
Last Name:HOLMES
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 1:5508 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2700
Mailing Address - Country:US
Mailing Address - Phone:208-386-3636
Mailing Address - Fax:
Practice Address - Street 1:5508 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2700
Practice Address - Country:US
Practice Address - Phone:208-386-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK167898122300000X
UT11778355-9922122300000X
NE7895122300000X
ID46710671223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist