Provider Demographics
NPI:1568974483
Name:HOLTMAN, DYLAN EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:EDWARD
Last Name:HOLTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3896 BETTYS PL
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2770
Mailing Address - Country:US
Mailing Address - Phone:770-845-0189
Mailing Address - Fax:
Practice Address - Street 1:428 REMINGTON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5525
Practice Address - Country:US
Practice Address - Phone:292-268-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0155161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice