Individual
MATTHEW K HOLDSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
4646 NANTUCKET DR, SUITE A, TOLEDO, OH 43623-3194
(419) 843-2121
(419) 517-2104
Mailing address
4646 NANTUCKET DR, SUITE A, TOLEDO, OH 43623-3194
(419) 843-2121
(419) 517-2104
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
30 02 1810
OH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
85282
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316284
ANTHEM BC
OH
05
—
2442575
—
OH
01
—
P00096800
RR MEDICARE
OH
Enumeration date
08/16/2005
Last updated
06/20/2011
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