Provider Demographics
NPI:1275981276
Name:HOLTZ, COLLEEN (DDS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:HOLTZ
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 1:1970 BUERKLE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1300
Mailing Address - Country:US
Mailing Address - Phone:651-337-5695
Mailing Address - Fax:
Practice Address - Street 1:1970 BUERKLE RD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-1300
Practice Address - Country:US
Practice Address - Phone:651-337-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist