Provider Demographics
NPI:1760693204
Name:HOLTZ, NORMAN LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:LOUIS
Last Name:HOLTZ
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 1:305 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3206
Mailing Address - Country:US
Mailing Address - Phone:516-887-2882
Mailing Address - Fax:516-887-2883
Practice Address - Street 1:305 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3206
Practice Address - Country:US
Practice Address - Phone:516-887-2882
Practice Address - Fax:516-887-2883
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0350361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice