MEDICARE: DR. STACIE LYNN HOLT D.D.S

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	22171	TX
2	1223G0001X	General Practice Dentistry	22158	TX

General Provider Information

NPI Number	:	1437173390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACIE LYNN HOLT D.D.S

Provider Business Mailing Address
First Line	:	1939 LAWRENCE RD
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-3122
Country	:	US
Telephone Number	:	281-538-9300
Fax Number	:	281-538-9031

Provider Business Practice Location Address
First Line	:	1939 LAWRENCE RD
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-3122
Country	:	US
Telephone Number	:	281-538-9300
Fax Number	:	281-538-9031

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/08/2015

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