Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 42053 | CA |
NPI | 1134259922 |
---|---|
Provider Name | Dr. Bruce Monte Holt |
First Address | Roseville, CA 95661-6045 |
Second Address | Roseville, CA 95661-6045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |