Stephen W Holm, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D-4057 Issued in ID

Practice address

3326 4TH St Ste 2
Lewiston, ID 83501-4455

Phone

(208) 743-1640

Fax

(208) 743-1643

NPI assigned

May 28, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 1, 2015 through Sep 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Facial Oral and Dental Implant Surgery Associates, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Lewiston, ID
  • NPI 1003060591
  NPD (past) Authorized official
• Facial Oral and Dental Implant Surgery Associates, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Pullman, WA
  • NPI 1730638180
  NPD (past) Authorized official
• Idaho Center for Oral and Facial Surgery

  • Oral and Maxillofacial Surgery Clinic/Center
  • Pocatello, ID
  • NPI 1558675298
  NPD (past)

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249257600000",
    "number": "1295993145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 4TH ST STE 2",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014455",
            "telephone_number": "208-743-1640",
            "fax_number": "208-743-1643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3326 4TH ST STE 2",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014455",
            "telephone_number": "208-743-1640",
            "fax_number": "208-743-1643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLM",
        "first_name": "STEPHEN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-28",
        "last_updated": "2009-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-4057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO SMILES",
            "identifier": "9212066",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808116400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hni Hospitalists of Idaho, LLC
• Hni Medical Services of Idaho, LLC
• John W. Ho, MD
• Rae Hodge, RPH
• Brian Arthur Hoffmann, M.D.
• Tayler Lyndsey Holman, NP
• Thomas Stephenson Holmes, M.D.
• Mandy Lea Hopkins, RN
• Sheri Katherine Horan, MSW, LCSW, LICSW
• Rebecca Lyn Horne, NP-C

• Oral and Maxillofacial Surgery (Dentist) in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.