Provider Demographics
NPI:1518961309
Name:HOLT, CHARLES E JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:HOLT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-4412
Mailing Address - Country:US
Mailing Address - Phone:423-756-0122
Mailing Address - Fax:423-756-1784
Practice Address - Street 1:1301 CARTER ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-4412
Practice Address - Country:US
Practice Address - Phone:423-756-0122
Practice Address - Fax:423-756-1784
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist