Provider Demographics
NPI:1124555933
Name:TRAVON HOLT DMD PC
Entity Type:Organization
Organization Name:TRAVON HOLT DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAHISAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-629-9290
Mailing Address - Street 1:3515 CAMP CREEK PT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-8140
Mailing Address - Country:US
Mailing Address - Phone:404-629-9290
Mailing Address - Fax:404-629-9335
Practice Address - Street 1:3515 CAMP CREEK PT
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-8140
Practice Address - Country:US
Practice Address - Phone:404-629-9290
Practice Address - Fax:404-629-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty