Individual
CHARLES BLAKE HOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9040A JACKSON AVENUE, TACOMA, WA 98431-0001
(253) 968-0367
Mailing address
9900 LINCOLN STREET 2ND FLOOR, TACOMA, WA 98431-0001
(253) 968-4079
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE61436740
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE61436740
DENTAL LICENSE
WA
Enumeration date
05/02/2023
Last updated
05/02/2023
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