Provider Demographics
NPI:1871808246
Name:HOLOMON, FREDWIN R (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDWIN
Middle Name:R
Last Name:HOLOMON
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:HQS USA DENTAC
Mailing Address - Street 2:M4861 LOGISTICS AVE
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-643-2196
Mailing Address - Fax:910-907-7904
Practice Address - Street 1:HQS USA DENTAC
Practice Address - Street 2:M4861 LOGISTICS AVE
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-643-2196
Practice Address - Fax:910-907-7904
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist