Provider Demographics
NPI:1659407146
Name:ELIZONDO, HOLDA ALICE (DDS)
Entity Type:Individual
Prefix:
First Name:HOLDA
Middle Name:ALICE
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5523 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581
Mailing Address - Country:US
Mailing Address - Phone:281-997-2001
Mailing Address - Fax:281-997-0173
Practice Address - Street 1:5523 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581
Practice Address - Country:US
Practice Address - Phone:281-997-2001
Practice Address - Fax:281-997-0173
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice