Provider Demographics
NPI:1558796136
Name:JOSEPH A. HOLTZ D.D.S. A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOSEPH A. HOLTZ D.D.S. A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-743-5700
Mailing Address - Street 1:726 E GRAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4446
Mailing Address - Country:US
Mailing Address - Phone:760-743-5700
Mailing Address - Fax:760-738-0400
Practice Address - Street 1:726 E GRAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4446
Practice Address - Country:US
Practice Address - Phone:760-743-5700
Practice Address - Fax:760-738-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty