Provider Demographics
NPI:1073949079
Name:SEGUIN FAMILY & IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:SEGUIN FAMILY & IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTZCLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:830-491-5385
Mailing Address - Street 1:404 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5524
Mailing Address - Country:US
Mailing Address - Phone:830-491-5385
Mailing Address - Fax:830-491-5454
Practice Address - Street 1:404 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5524
Practice Address - Country:US
Practice Address - Phone:830-491-5385
Practice Address - Fax:830-491-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty