Provider Demographics
NPI:1821519505
Name:HOLTZ, JAIME ELLEN (DDS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ELLEN
Last Name:HOLTZ
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 1:387 NE 223RD AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8554
Mailing Address - Country:US
Mailing Address - Phone:503-491-5450
Mailing Address - Fax:
Practice Address - Street 1:387 NE 223RD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8554
Practice Address - Country:US
Practice Address - Phone:503-491-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD106591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice