Provider Demographics
NPI:1922116706
Name:HOLZER, TERESA ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANNE
Last Name:HOLZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:HOLZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS PC
Mailing Address - Street 1:321 HIGH SCHOOL RD NE SUITE D3
Mailing Address - Street 2:PMB 137
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:425-349-5600
Mailing Address - Fax:425-349-5601
Practice Address - Street 1:12199 VILLAGE CENTER PLACE
Practice Address - Street 2:SUITE 204
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275
Practice Address - Country:US
Practice Address - Phone:425-349-5600
Practice Address - Fax:425-349-5601
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1774122300000X
ORD7431122300000X
WADE000081451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist