DR. JACK ROBERT HOLT (NPI# 1629293618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629293618 |
Entity Type | Individual |
Full Name | DR. JACK ROBERT HOLT |
Credential | DDS |
Practice Address |
1213 Coffee Rd Suite M Modesto CA 95355-4229 |
Practice Telephone | 2095215959 |
Practice Fax Number | 2095211082 |
Mailing Telephone | 2095215959 |
Mailing Fax Number | 2095211082 |
Enumeration Date | 2007-04-16 |
Last Update Date | 2013-05-09 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 122300000X | Dentist | 16922 | CA | Dental Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104168624 | Jack L Holt | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2013-03-22 |
Street Address |
1213 COFFEE RD SUITE M |
City | MODESTO |
State | CA |
Zip Code | 95355-4229 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023017225 | David Aaron Woodruff | Dentist | 1213 Coffee Rd, Suite K, Modesto, CA 95355-4229 | 2005-07-19 |
1548646839 | Edwin Y. Josephs Dds, Inc | Dentist | 1213 Coffee Rd, Ste. J, Modesto, CA 95355-4229 | 2015-08-10 |
1427391044 | Amanda Pearl Farley | Dentist | 1213 Coffee Rd, Suite C, Modesto, CA 95355-4229 | 2013-04-02 |
1366713018 | Betty Kilpatrick Hansen | Marriage & Family Therapist | 1213 Coffee Rd, Suite P, Modesto, CA 95355-4229 | 2012-01-25 |
1225320211 | Kelly Gaines | Family Medicine | 1213 Coffee Rd, Modesto, CA 95355-4229 | 2011-05-09 |
1568654986 | Brian Kelly Hutto | Dentist | 1213 Coffee Rd, Suite D, Modesto, CA 95355-4229 | 2007-08-10 |
1821110586 | Meridith Mccurdy-yeoman | Physician Assistant | 1213 Coffee Rd, Modesto, CA 95355-4229 | 2007-04-04 |
1598886178 | George J Di Cristina | Dentist | 1213 Coffee Rd, Suite J, Modesto, CA 95355-4229 | 2007-04-02 |
1073639043 | Sylvia Diane Victor | Marriage & Family Therapist | 1213 Coffee Rd, Suite P, Modesto, CA 95355-4229 | 2007-03-22 |
1588704951 | Lance Bautista | Dentist | 1213 Coffee Rd, Modesto, CA 95355-4229 | 2007-02-07 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982211793 | I To I LLC | Optometrist | 3401 Oakdale Rd, Ste 525, Modesto, CA 95355 | 2020-09-25 |
1205443116 | Altwal and Shelat Dds Inc | Dentist | 1317 Oakdale Road, Suite 310, Modesto, CA 95355 | 2020-09-24 |
1184255911 | Reeves, D.d.s. and Lavalley, D.d.s., A Dental Corporation | Clinic/Center | 3401 Oakdale Road, Suite 505, Modesto, CA 95355 | 2020-01-30 |
1487133856 | Natalie Vargas | Behavior Technician | 1317 Oakdale Road Suite 610, Modesto, CA 95355 | 2018-08-07 |
1871079152 | Jill H Fusia | Dietitian, Registered | 1404 Cordero Court, Modesto, CA 95355 | 2018-07-19 |
1043727514 | Emily Lauren Schaefer | Behavioral Analyst | 3425 Coffee Rd Ste C2, Modesto, CA 95355 | 2018-01-05 |
1376083691 | Hari Gnanasekeram, PC | Technician, Cardiology | 1303 Mable Avenu, Modesto, CA 95355 | 2017-03-06 |
1598139891 | Encompass Health Rehabilitation Hospital of Modesto, LLC | Rehabilitation Hospital | 1303 Mable Avenue, Modesto, CA 95355 | 2015-11-24 |
1013387844 | Diana Faith Kigenyi | Social Worker | 1225 Oakdale Road, Modesto, CA 95355 | 2015-10-06 |
1437530672 | Tzu Yi Wei | Acupuncturist | 2209 Coffee Road, Suite A, Modesto, CA 95355 | 2015-06-12 |
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Taxonomy Code | 122300000X |
Grouping | Dental Providers |
Classification | Dentist |
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
Notes: Source: Council on Dental Education and Licensure, American Dental Association |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205443116 | Altwal and Shelat Dds Inc | Dentist | 1317 Oakdale Road, Suite 310, Modesto, CA 95355 | 2020-09-24 |
1306310933 | Western Dental Services, Inc. | Dentist | 2605 Coffee Rd Ste 200, Modesto, CA 95355-2064 | 2019-01-16 |
1205320223 | Western Dental Services, Inc. | Dentist | 2900 Standiford Ave Ste 2, Modesto, CA 95350-6575 | 2018-06-22 |
1215438130 | Lopez Dental Corporation | Dentist | 3601 Pelandale Ave Ste D-1, Modesto, CA 95356-9808 | 2018-02-26 |
1053820522 | Pannu and Henne Dental Corp. | Dentist | 3219 Mc Henry Ave, Suite E, Modesto, CA 95350 | 2017-09-27 |
1013457118 | Kaur and Borrero Dds Dental Corp | Dentist | 1801 Tully Rd Ste A1, Modesto, CA 95350-2937 | 2017-03-08 |
1821461104 | Michael Lopez Dental Corporation | Dentist | 2103 Mchenry Avenue, Suite C, Modesto, CA 95350 | 2015-11-09 |
1760899884 | David Merrill Paxman | Dentist | 400 E Orangeburg Ave Ste 4, Modesto, CA 95350-5365 | 2014-07-21 |
1083021323 | Maninder Kaur Dhillon | Dentist | 1912 Standiford Ave Ste 1, Modesto, CA 95350-6507 | 2014-07-18 |
1043621618 | Nicholas Poblete | Dentist | 1316 Coffee Rd., Bldg. C, Modesto, CA 95355 | 2014-05-16 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.