Provider Demographics
NPI:1316939507
Name:HOLDSHIP, MATTHEW K (DDS MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:HOLDSHIP
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 NANTUCKET DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3194
Mailing Address - Country:US
Mailing Address - Phone:419-843-2121
Mailing Address - Fax:419-517-2104
Practice Address - Street 1:4646 NANTUCKET DR
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3194
Practice Address - Country:US
Practice Address - Phone:419-843-2121
Practice Address - Fax:419-517-2104
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 02 18101223S0112X
OH852821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000316284OtherANTHEM BC
OH2442575Medicaid
OHP00096800OtherRR MEDICARE
OH4122911Medicare PIN
OH000000316284OtherANTHEM BC
OH4122912Medicare PIN
OH4122913Medicare PIN