NPIMap

Organization Active NPI

Keith Holm LLC

  • Dentist
  • El Mirage, AZ
National Provider Identifier
1417441767
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D7138 Issued in AZ
Legal business name
KEITH HOLM LLC
Practice address
13915 N Dysart Rd Ste A1
El Mirage, AZ 85335-7333
Phone
(623) 444-6340
Fax
(623) 444-6350
NPI assigned
Jun 20, 2018
Last updated
Jun 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Dr. Keith Holm, DMDNPI 1730210980
Title
Owner
Phone
(623) 251-9767

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
Dentist 122300000X D7138 AZ Primary

Addresses

Primary practice location

13915 N Dysart Rd Ste A1
El Mirage, AZ 85335-7333

Mailing address

13915 N Dysart Rd Ste A1
El Mirage, AZ 85335-7333
Phone (623) 444-6340

Other names 1

  • Little Smiles of Surprise Other name

National Provider Directory

National Provider Directory

Locations

13915 N Dysart Rd
Ste A1
El Mirage, AZ 85335
Phone (623) 444-6340

Practitioners & affiliated clinicians

Practitioners 3

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": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1417441767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13915 N DYSART RD STE A1",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853357333",
            "telephone_number": "623-444-6340",
            "fax_number": "623-444-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13915 N DYSART RD STE A1",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853357333",
            "telephone_number": "623-444-6340",
            "fax_number": "623-444-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH HOLM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "HOLM",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-251-9767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D7138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Smiles of Surprise",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in El Mirage, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.