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General NPI Number Information
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NPI Number | 1861139172
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Entity Type | Organization
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Legal Business Name | DANNY J. HOLTZCLAW, DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 690 OTAY LAKES RD STE 260
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City | CHULA VISTA
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State | CA
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Zip | 91910-8904
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Country | US
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Telephone | 619-482-3264
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Fax |
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Provider Business Mailing Address
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Address Line | 690 OTAY LAKES RD STE 260
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City | CHULA VISTA
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State | CA
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Zip | 91910-8904
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Country | US
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Telephone | 619-482-3264
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANNY J HOLTZACLAW
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Credential | DDS
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Telephone | 619-482-3264
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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 |
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License Number State |
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