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General NPI Number Information
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NPI Number | 1508061342
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Entity Type | Individual
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Provider Name | SAMUEL G HOLTZCLAW JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 308 HIGHWAY 14
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6054
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Country | US
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Telephone | 864-963-3481
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Fax | 864-963-0351
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Provider Business Mailing Address
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Address Line | 308 HIGHWAY 14
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6054
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Country | US
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Telephone | 864-963-3481
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Fax | 864-963-0351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4323
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License Number State | SC
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