Provider Demographics
NPI:1588811426
Name:HOLT, ROBERT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
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 1:4120 LAUREL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5592
Mailing Address - Country:US
Mailing Address - Phone:909-708-7936
Mailing Address - Fax:877-230-4680
Practice Address - Street 1:4120 LAUREL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5592
Practice Address - Country:US
Practice Address - Phone:909-708-7936
Practice Address - Fax:877-230-4680
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0331001223P0300X
AK14761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics