Individual
JASON HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3522 W LISBON AVE, MILWAUKEE, WI 53208-1953
(414) 935-8000
(414) 344-3350
Mailing address
3522 W LISBON AVE, MILWAUKEE, WI 53208-1953
(423) 741-5780
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
100218515
WI
Other
Enumeration date
02/16/2017
Last updated
04/22/2020
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