Provider Demographics
NPI:1902814098
Name:HOLT, GERALD H JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:H
Last Name:HOLT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FLAG LAKE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6214
Mailing Address - Country:US
Mailing Address - Phone:979-297-6762
Mailing Address - Fax:
Practice Address - Street 1:102 FLAG LAKE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6214
Practice Address - Country:US
Practice Address - Phone:979-297-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice