MEDICARE: CODY RAY HOLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	36823	TX

General Provider Information

NPI Number	:	1023619921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY RAY HOLT

Provider Business Mailing Address
First Line	:	9500 INDEPENDENCE DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-4686
Country	:	US
Telephone Number	:	907-349-4343
Fax Number	:	907-344-4963

Provider Business Practice Location Address
First Line	:	9500 INDEPENDENCE DR STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-4617
Country	:	US
Telephone Number	:	907-349-4343
Fax Number	:	907-344-4963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	09/19/2022

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Directions to “ CODY RAY HOLT ” Practice Location

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