MEDICARE: DR. BRUCE HOLZ DDS

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	1223G0001X	General Practice Dentistry	0007272	FL

General Provider Information

NPI Number	:	1285620807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE HOLZ DDS

Provider Business Mailing Address
First Line	:	2320 NE 53RD ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3212
Country	:	US
Telephone Number	:	954-492-8126
Fax Number	:	954-771-7505

Provider Business Practice Location Address
First Line	:	2320 NE 53RD ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3212
Country	:	US
Telephone Number	:	954-492-8126
Fax Number	:	954-771-7505

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/23/2007

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