Provider Demographics
NPI:1225371461
Name:HOLT, KIMBERLY GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:GAIL
Last Name:HOLT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5072 W PLANO PKWY
Mailing Address - Street 2:# 180
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4476
Mailing Address - Country:US
Mailing Address - Phone:972-713-6644
Mailing Address - Fax:972-713-6794
Practice Address - Street 1:5072 W PLANO PKWY
Practice Address - Street 2:# 180
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4476
Practice Address - Country:US
Practice Address - Phone:972-713-6644
Practice Address - Fax:972-713-6794
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics