Provider Demographics
NPI:1851393714
Name:HOLT, JOHN BENJAMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:HOLT
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 1:5 N SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3827
Mailing Address - Country:US
Mailing Address - Phone:503-635-3438
Mailing Address - Fax:503-697-3803
Practice Address - Street 1:5 N SHORE RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3827
Practice Address - Country:US
Practice Address - Phone:503-635-3438
Practice Address - Fax:503-697-3803
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist