Chanelle Marie Holder, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

14166 Issued in CT

Practice address

2109 Victory Blvd
Staten Island, NY 10314-6601

Phone

(718) 494-1300

NPI assigned

Jul 22, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• One Endo Support Services

  • Endodontics
  • Mamaroneck, NY
  • NPI 1780332973
  NPD (past)

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1669200820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 54TH ST APT 307",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100225297",
            "telephone_number": "347-969-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146601",
            "telephone_number": "718-494-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "83 East Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068514918",
            "country_code": "US",
            "telephone_number": "203-952-0555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLDER",
        "first_name": "CHANELLE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CT",
            "license": "14166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Hoffnung, PHD
• Ethel Hofman-Zimmerman, PT
• Cendrella Sassine Hojeily, MD
• Charles S Holburn, PH.D. BCBA-D
• Stefani Holden
• Giovanny Holguin, MD
• Cassidy Brooke Hollander, OTR
• Deborah Patricia Holly, L.C.S.W.
• Ulrika A Holm, M.D.
• Lauren Holman

• Endodontics in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Endodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; 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.