Provider Demographics
NPI:1447568357
Name:HOLDSWORTH, MARTHA PRUITT (RDH)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:PRUITT
Last Name:HOLDSWORTH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8579 IVOR ROAD
Mailing Address - Street 2:
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866
Mailing Address - Country:US
Mailing Address - Phone:757-859-9070
Mailing Address - Fax:757-859-9075
Practice Address - Street 1:8579 IVOR ROAD
Practice Address - Street 2:
Practice Address - City:IVOR
Practice Address - State:VA
Practice Address - Zip Code:23866
Practice Address - Country:US
Practice Address - Phone:757-859-9070
Practice Address - Fax:757-859-9075
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402003504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist