Provider Demographics
NPI:1386768141
Name:HOLT, MARIE CORBISIERO (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:CORBISIERO
Last Name:HOLT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9629
Mailing Address - Country:US
Mailing Address - Phone:317-576-9393
Mailing Address - Fax:
Practice Address - Street 1:7862 E 96TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9629
Practice Address - Country:US
Practice Address - Phone:317-576-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice