Provider Demographics
NPI:1487069647
Name:THOMAS A. HOLT DDS PLLC
Entity type:Organization
Organization Name:THOMAS A. HOLT DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-413-8525
Mailing Address - Street 1:27016 MAPLE VALLEY BLACK DIAMOND ROAD SOUTH EAST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038
Mailing Address - Country:US
Mailing Address - Phone:425-413-8525
Mailing Address - Fax:425-413-8599
Practice Address - Street 1:27016 MAPLE VALLEY BLACK DIAMOND ROAD SOUTH EAST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-413-8525
Practice Address - Fax:425-413-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty