1972853562 NPI number — DR. AMON EUGENE HOLT III D.D.S.

Table of content: DR. AMON EUGENE HOLT III D.D.S. (NPI 1972853562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972853562 NPI number — DR. AMON EUGENE HOLT III D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLT
Provider First Name:
AMON
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLT
Provider Other First Name:
TREY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972853562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
975 N MUR LEN RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66062-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-415-2000
Provider Business Mailing Address Fax Number:
913-415-2004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 N MUR LEN RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-415-2000
Provider Business Practice Location Address Fax Number:
913-415-2004
Provider Enumeration Date:
09/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  61063 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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