Provider Demographics
NPI:1437173390
Name:HOLT, STACIE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LYNN
Last Name:HOLT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:LYNN
Other - Last Name:DEVAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1939 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-3122
Mailing Address - Country:US
Mailing Address - Phone:281-538-9300
Mailing Address - Fax:281-538-9031
Practice Address - Street 1:1939 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-3122
Practice Address - Country:US
Practice Address - Phone:281-538-9300
Practice Address - Fax:281-538-9031
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221711223G0001X
TX221581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice