MEDICARE: DR. CHARLES E HOLT JR. 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	122300000X	Dentist	DS3750	TN

General Provider Information

NPI Number	:	1518961309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E HOLT JR. DDS

Provider Business Mailing Address
First Line	:	1301 CARTER ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-4412
Country	:	US
Telephone Number	:	423-756-0122
Fax Number	:	423-756-1784

Provider Business Practice Location Address
First Line	:	1301 CARTER ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-4412
Country	:	US
Telephone Number	:	423-756-0122
Fax Number	:	423-756-1784

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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