MEDICARE: JOHN 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	00203191	CO

General Provider Information

NPI Number	:	1598285462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN HOLT

Provider Business Mailing Address
First Line	:	7935 CONSTITUTION AVE STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-8903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7935 CONSTITUTION AVE STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-8903
Country	:	US
Telephone Number	:	719-596-9668
Fax Number	:

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

Provider Enumeration Date	:	06/22/2017
Last Update Date	:	06/22/2017

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Directions to “ JOHN HOLT ” Practice Location

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