Provider Demographics
NPI:1437384500
Name:HOLT, NATHAN C (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:C
Last Name:HOLT
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 1:219 E 12300 S
Mailing Address - Street 2:SUITE I-5
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6970
Mailing Address - Country:US
Mailing Address - Phone:801-495-4440
Mailing Address - Fax:801-495-4442
Practice Address - Street 1:219 E 12300 S
Practice Address - Street 2:SUITE I-5
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6970
Practice Address - Country:US
Practice Address - Phone:801-495-4440
Practice Address - Fax:801-495-4442
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5487756-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice