Healthcare Provider Details

I. General information

NPI: 1023027885
Provider Name (Legal Business Name): JENNIFER S. HOLT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SOUTH CENTRAL AVE.
UMATILLA FL
32784
US

IV. Provider business mailing address

413 E ORANGE AVE 285 SOUTH CENTRAL AVE.
EUSTIS FL
32726-4162
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-3185
  • Fax: 352-669-1051
Mailing address:
  • Phone: 352-669-3185
  • Fax: 352-669-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN15495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: