Healthcare Provider Details

I. General information

NPI: 1376563098
Provider Name (Legal Business Name): MICHAEL HOLT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BROOKDALE DR SUITE 400
CHARLOTTE NC
28215-8725
US

IV. Provider business mailing address

9601 BROOKDALE DR SUITE 400
CHARLOTTE NC
28215-8725
US

V. Phone/Fax

Practice location:
  • Phone: 704-599-3901
  • Fax: 704-213-3119
Mailing address:
  • Phone: 704-599-3901
  • Fax: 704-213-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7369
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: