Provider Demographics
NPI:1033148960
Name:HOLDORF, BRUCE ALLEN (DMD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALLEN
Last Name:HOLDORF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29802-1057
Mailing Address - Country:US
Mailing Address - Phone:803-649-0044
Mailing Address - Fax:803-643-0570
Practice Address - Street 1:341 NEWBERRY ST NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-649-0044
Practice Address - Fax:803-643-0570
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
972848OtherUNITED CONCORDIA
SCZ31118Medicaid