Individual provider · Type 1 NPI

Jack Carter Holley, DMD

Student in an Organized Health Care Education/Training Program · Seminole, FL

NPI number 1376235259 Active

Practice location

9200 113th St
Seminole, FL 33772-2800

Call (727) 893-5050 Map

Mailing address

430 3rd Ave S Apt 107
St. Petersburg, FL 33701-4144

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XDN31951 (FL)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1376235259

Jack Carter Holley, DMD's National Provider Identifier is 1376235259, issued on May 22, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Seminole, FL. The record was last updated on Sep 28, 2026.