Provider Demographics
NPI:1851302285
Name:HOLT AND ASSOCIATES D.D.S., P. A.
Entity Type:Organization
Organization Name:HOLT AND ASSOCIATES D.D.S., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-982-4520
Mailing Address - Street 1:1100 JOHN HARDEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3161
Mailing Address - Country:US
Mailing Address - Phone:501-982-4520
Mailing Address - Fax:501-982-7450
Practice Address - Street 1:1100 JOHN HARDEN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3161
Practice Address - Country:US
Practice Address - Phone:501-982-4520
Practice Address - Fax:501-982-7450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1790709087OtherINDIVIDUAL NPI NUMBER