NPIMap

Organization Active NPI

Brent L Holman DDS PC

  • Pediatric Dentistry
  • Fargo, ND
National Provider Identifier
1265595995
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
1587 Issued in ND
Legal business name
BRENT L HOLMAN DDS PC
Practice address
2538 University Dr S
Suite a
Fargo, ND 58103-5737
Phone
(701) 232-1148
Fax
(701) 232-8907
NPI assigned
Dec 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brent L Holman, DDSNPI 1528121258
Title
President
Phone
(701) 232-1148

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 1587 ND Primary

Addresses

Primary practice location

2538 University Dr S
Suite a
Fargo, ND 58103-5737

Mailing address

2538 University Dr S
Suite a
Fargo, ND 58103-5737
Phone (701) 232-1148

Other identifiers 4

IdentifierTypeStateIssuer
40633MedicaidND
91799110OtherMNBLUE CROSS BLUE SHIELD
330OtherMNDELTA DENTAL
26296OtherNDND BLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265595995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2538 UNIVERSITY DR S",
            "address_2": "SUITE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035737",
            "telephone_number": "701-232-1148",
            "fax_number": "701-232-8907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2538 UNIVERSITY DR S",
            "address_2": "SUITE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035737",
            "telephone_number": "701-232-1148",
            "fax_number": "701-232-8907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT L HOLMAN DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLMAN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-232-1148",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "ND",
            "license": "1587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40633",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "91799110",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "330",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BLUE CROSS BLUE SHIELD",
            "identifier": "26296",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.