Provider Demographics
NPI:1366563520
Name:HOLTON, TODD ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ROBERT
Last Name:HOLTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 GOLF VIEW DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-773-4435
Mailing Address - Fax:541-494-1453
Practice Address - Street 1:737 GOLF VIEW DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-773-4435
Practice Address - Fax:541-494-1453
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice