Healthcare Provider Details

I. General information

NPI: 1740775675
Provider Name (Legal Business Name): NATHANIEL ALEXANDER HOLT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2018
Last Update Date: 08/08/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 PEPPERRELL ST
SAN ANTONIO TX
78236-5313
US

IV. Provider business mailing address

1618 ESTONIA GREY
SAN ANTONIO TX
78251-2597
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10093
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.033566
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1002487-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: