Provider Demographics
NPI:1104165109
Name:JANE R HOLT DDS PA
Entity type:Organization
Organization Name:JANE R HOLT DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-859-1000
Mailing Address - Street 1:218 ASHVILLE AVE
Mailing Address - Street 2:SUITE 60
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6118
Mailing Address - Country:US
Mailing Address - Phone:919-859-1000
Mailing Address - Fax:919-249-1381
Practice Address - Street 1:218 ASHVILLE AVE
Practice Address - Street 2:SUITE 60
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6118
Practice Address - Country:US
Practice Address - Phone:919-859-1000
Practice Address - Fax:919-249-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty