Provider Demographics
NPI:1669434650
Name:HOLTZCLAW, DANNY JACK (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:JACK
Last Name:HOLTZCLAW
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 SANDY BROOK DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1518
Mailing Address - Country:US
Mailing Address - Phone:512-375-0050
Mailing Address - Fax:512-682-9009
Practice Address - Street 1:4010 SANDY BROOK DR STE 204
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1518
Practice Address - Country:US
Practice Address - Phone:512-375-0500
Practice Address - Fax:512-682-9009
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203291223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice