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General NPI Number Information
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NPI Number | 1588274914
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Entity Type | Organization
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Legal Business Name | JEREMIAH HOLDER, INC.
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 1365 HENLEY ST APT 504
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City | NAPLES
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State | FL
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Zip | 34105-4865
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Country | US
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Telephone | 239-529-7159
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 HENLEY ST APT 504
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City | NAPLES
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State | FL
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Zip | 34105-4865
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Country | US
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Telephone | 239-529-7159
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JEREMIAH HOLDER
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Credential | CDT
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Telephone | 239-529-7159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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