Healthcare Provider Details

I. General information

NPI: 1023633351
Provider Name (Legal Business Name): JADEN PATRICK HOLTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 GRAND AVE
SPENCER IA
51301-3631
US

IV. Provider business mailing address

820 GRAND AVE
SPENCER IA
51301-3631
US

V. Phone/Fax

Practice location:
  • Phone: 712-580-3038
  • Fax: 319-774-8824
Mailing address:
  • Phone: 712-580-3038
  • Fax: 319-774-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS-10326
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: