MEDICARE: DR. GARY LEE HOLTZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.014437	OH

General Provider Information

NPI Number	:	1326087545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LEE HOLTZ D.D.S.

Provider Business Mailing Address
First Line	:	1208 BELL RD
Second Line	:
City	:	SOUTH RUSSELL
State	:	OH
Zip	:	44022-4254
Country	:	US
Telephone Number	:	440-338-1711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 BELL RD
Second Line	:
City	:	SOUTH RUSSELL
State	:	OH
Zip	:	44022-4254
Country	:	US
Telephone Number	:	440-338-1711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	04/30/2008

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