MEDICARE: DR. BRIAN AARON HOLTAN DMD

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	122300000X	Dentist	D011188	AZ

General Provider Information

NPI Number	:	1417626060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN AARON HOLTAN DMD

Provider Business Mailing Address
First Line	:	13909 W CAMINO DEL SOL STE 102
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-1413
Country	:	US
Telephone Number	:	623-584-9844
Fax Number	:

Provider Business Practice Location Address
First Line	:	13909 W CAMINO DEL SOL STE 102
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-1413
Country	:	US
Telephone Number	:	623-584-9844
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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