Provider Demographics
NPI:1578632204
Name:HOLTMAN, JOHN BERNARD (DMD PSC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BERNARD
Last Name:HOLTMAN
Suffix:
Gender:M
Credentials:DMD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 DUTCHMANS LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-895-0797
Mailing Address - Fax:502-895-1328
Practice Address - Street 1:3932 DUTCHMANS LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-895-0797
Practice Address - Fax:502-895-1328
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
3917OtherKENTUCKY ST LICENSE NUMBE