Provider Demographics
NPI:1174737472
Name:HOLMBERG, LARS ERIK (DDS)
Entity type:Individual
Prefix:
First Name:LARS
Middle Name:ERIK
Last Name:HOLMBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:L
Other - Middle Name:ERIK
Other - Last Name:HOLMBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:222 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-663-1161
Mailing Address - Fax:
Practice Address - Street 1:222 N MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-663-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist