Provider Demographics
NPI:1508061342
Name:HOLTZCLAW, SAMUEL G JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:G
Last Name:HOLTZCLAW
Suffix:JR
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 1:308 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6054
Mailing Address - Country:US
Mailing Address - Phone:864-963-3481
Mailing Address - Fax:864-963-0351
Practice Address - Street 1:308 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6054
Practice Address - Country:US
Practice Address - Phone:864-963-3481
Practice Address - Fax:864-963-0351
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice