Provider Demographics
NPI:1659313856
Name:HOLDER, TERRY W (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:W
Last Name:HOLDER
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 1:5107 TOWNSHIP RIDGE TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1733
Mailing Address - Country:US
Mailing Address - Phone:770-826-9282
Mailing Address - Fax:770-998-3710
Practice Address - Street 1:5107 TOWNSHIP RIDGE TRCE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1733
Practice Address - Country:US
Practice Address - Phone:770-826-9282
Practice Address - Fax:770-998-3710
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry