Provider Demographics
NPI:1558458703
Name:MARK H. HOLT, DDS, MS, INC
Entity Type:Organization
Organization Name:MARK H. HOLT, DDS, MS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:916-786-9282
Mailing Address - Street 1:1421 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE #121
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6045
Mailing Address - Country:US
Mailing Address - Phone:916-786-9282
Mailing Address - Fax:916-786-0776
Practice Address - Street 1:1421 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE #121
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6045
Practice Address - Country:US
Practice Address - Phone:916-786-9282
Practice Address - Fax:916-786-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty