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General NPI Number Information
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NPI Number | 1194593517
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Entity Type | Organization
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Legal Business Name | SHALISE M HOLT DDS MS PC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 9184 DARROW RD
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City | TWINSBURG
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State | OH
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Zip | 44087
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Country | US
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Telephone | 872-704-0701
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Fax |
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Provider Business Mailing Address
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Address Line | 7334 STOCKWOOD DR
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City | SOLON
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State | OH
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Zip | 44139-5681
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Country | US
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Telephone | 419-357-3811
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHALISE MARIE HOLT
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Credential | DDS MS
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Telephone | 872-704-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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