Provider Demographics
NPI:1376563098
Name:HOLT, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BROOKDALE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8725
Mailing Address - Country:US
Mailing Address - Phone:704-599-3901
Mailing Address - Fax:704-213-3119
Practice Address - Street 1:9601 BROOKDALE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8725
Practice Address - Country:US
Practice Address - Phone:704-599-3901
Practice Address - Fax:704-213-3119
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015N0OtherNC HEALTHCHOICE
NC5901086Medicaid