Provider Demographics
NPI:1699750810
Name:HOLZER, GEORGE JOHN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOHN
Last Name:HOLZER
Suffix:JR
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 1:3025 NICHOLS VALE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4424
Mailing Address - Country:US
Mailing Address - Phone:703-409-3762
Mailing Address - Fax:
Practice Address - Street 1:3025 NICHOLS VALE
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4424
Practice Address - Country:US
Practice Address - Phone:703-409-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014119861223G0001X
WADE 604707521223G0001X
PADS026404L1223G0001X
TN11566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice