Provider Demographics
NPI:1568974483
Name:HOLTMAN, DYLAN EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:EDWARD
Last Name:HOLTMAN
Suffix:
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 1:24 HOLTMAN RDG
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:GA
Mailing Address - Zip Code:30171-1030
Mailing Address - Country:US
Mailing Address - Phone:770-845-0189
Mailing Address - Fax:
Practice Address - Street 1:201 S PARK AVE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2441
Practice Address - Country:US
Practice Address - Phone:706-629-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0155161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice