Provider Demographics
NPI:1285620807
Name:HOLZ, BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:HOLZ
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 1:2320 NE 53RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3212
Mailing Address - Country:US
Mailing Address - Phone:954-492-8126
Mailing Address - Fax:954-771-7505
Practice Address - Street 1:2320 NE 53RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3212
Practice Address - Country:US
Practice Address - Phone:954-492-8126
Practice Address - Fax:954-771-7505
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00072721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice