Provider Demographics
NPI:1023027885
Name:HOLT, JENNIFER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:HOLT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E ORANGE AVE
Mailing Address - Street 2:285 SOUTH CENTRAL AVE.
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-4162
Mailing Address - Country:US
Mailing Address - Phone:352-669-3185
Mailing Address - Fax:352-669-1051
Practice Address - Street 1:285 SOUTH CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784
Practice Address - Country:US
Practice Address - Phone:352-669-3185
Practice Address - Fax:352-669-1051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice