Provider Demographics
NPI:1063525939
Name:BRIAN R. HOLT, DDS PA
Entity type:Organization
Organization Name:BRIAN R. HOLT, DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-843-7726
Mailing Address - Street 1:108 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2820
Mailing Address - Country:US
Mailing Address - Phone:501-843-7726
Mailing Address - Fax:501-843-3561
Practice Address - Street 1:108 S 10TH ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2820
Practice Address - Country:US
Practice Address - Phone:501-843-7726
Practice Address - Fax:501-843-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T017OtherBLUE CROSS BLUE SHIELD
AR1458718OtherUCCI