Provider Demographics
NPI:1639138498
Name:HOLTERY, ANDY S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:S
Last Name:HOLTERY
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 1:6028 STERLING RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1535
Mailing Address - Country:US
Mailing Address - Phone:407-310-7032
Mailing Address - Fax:
Practice Address - Street 1:136 PARTIN DR N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2054
Practice Address - Country:US
Practice Address - Phone:850-678-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice