Provider Demographics
NPI:1013930551
Name:HOLT, LARRY RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RAY
Last Name:HOLT
Suffix:
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 1:935 4TH STREET DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3950
Mailing Address - Country:US
Mailing Address - Phone:828-322-2977
Mailing Address - Fax:828-322-6794
Practice Address - Street 1:935 4TH STREET DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3950
Practice Address - Country:US
Practice Address - Phone:828-322-2977
Practice Address - Fax:828-322-6794
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU29001Medicare UPIN