Provider Demographics
NPI:1750559266
Name:HOLZINGER, JEFFREY WALTON (DDS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WALTON
Last Name:HOLZINGER
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 1:9200 BONITA BEACH RD SE
Mailing Address - Street 2:SUITE #112
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-992-2279
Mailing Address - Fax:239-992-3364
Practice Address - Street 1:9200 BONITA BEACH RD SE
Practice Address - Street 2:SUITE #112
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4280
Practice Address - Country:US
Practice Address - Phone:239-992-2279
Practice Address - Fax:239-992-3364
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL72731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice