Provider Demographics
NPI:1417626060
Name:HOLTAN, BRIAN AARON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:AARON
Last Name:HOLTAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13909 W CAMINO DEL SOL STE 102
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-1413
Mailing Address - Country:US
Mailing Address - Phone:623-584-9844
Mailing Address - Fax:
Practice Address - Street 1:13909 W CAMINO DEL SOL STE 102
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-1413
Practice Address - Country:US
Practice Address - Phone:623-584-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist