Healthcare Provider Details

I. General information

NPI: 1326002759
Provider Name (Legal Business Name): GERALD H HOLZIMMER D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11662 MARTIN RD
WARREN MI
48093-4588
US

IV. Provider business mailing address

11662 MARTIN RD
WARREN MI
48093-4588
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-2650
  • Fax: 586-754-6407
Mailing address:
  • Phone: 586-755-2650
  • Fax: 586-754-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number08056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: