MEDICARE: DR. DENNIS MICHAEL HOLT D.M.D

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	1223E0200X	Endodontics	D7521	OR

General Provider Information

NPI Number	:	1740402817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS MICHAEL HOLT D.M.D

Provider Business Mailing Address
First Line	:	88TH MEDICAL GROUP 4881 SUGAR MAPLE DRIVE
Second Line	:
City	:	WPAFB
State	:	OH
Zip	:	45433
Country	:	US
Telephone Number	:	937-257-9576
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 TRUEMPER ST
Second Line	:
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-292-0750
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/12/2023

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