Provider Demographics
NPI:1841371135
Name:HOLTON, JAMES BARRY (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BARRY
Last Name:HOLTON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1937
Mailing Address - Country:US
Mailing Address - Phone:903-592-1664
Mailing Address - Fax:903-592-6595
Practice Address - Street 1:805 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1937
Practice Address - Country:US
Practice Address - Phone:903-592-1664
Practice Address - Fax:903-592-6595
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX86811223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L740OtherBC/BS #
TX130586402Medicaid
TX130586404Medicaid
TX130586406Medicaid
TX751572652OtherTAX ID#
TX8F1882Medicare PIN
TX00L740OtherBC/BS #