Provider Demographics
NPI:1194748772
Name:HOLSTEIN, BURT M (DDS)
Entity type:Individual
Prefix:DR
First Name:BURT
Middle Name:M
Last Name:HOLSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 442
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2412
Mailing Address - Country:US
Mailing Address - Phone:323-653-2315
Mailing Address - Fax:323-653-2327
Practice Address - Street 1:8383 WILSHIRE BLVD
Practice Address - Street 2:SUITE 442
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2412
Practice Address - Country:US
Practice Address - Phone:323-653-2315
Practice Address - Fax:323-653-2327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice