Shalise Marie Holt, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021.002884 Issued in IL

Practice address

4001 N Mulford Rd
Loves Park, IL 61111-6949

Phone

(815) 877-6453

NPI assigned

Sep 5, 2018

Last updated

Sep 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shalise M Holt DDS Ms PC

  dba Holt Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Twinsburg, OH
  • NPI 1194593517
  NPD Authorized official
• Vincent Zammuto DDS LTD

  dba Mulford Dental Group

  • General Practice Dentistry
  • Loves Park, IL
  • NPI 1891910451
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1164904272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 N MULFORD RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611116949",
            "telephone_number": "815-877-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 N MULFORD RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611116949",
            "telephone_number": "815-877-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLT",
        "first_name": "SHALISE",
        "middle_name": "MARIE",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-05",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021.002884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Hermanson
• Dakota Chance Thomas Heshelman, LCPC
• Highland Park CVS LLC (CVS Pharmacy # 08530)
• Roger H Hill, OD
• Kaari L Hobson, LCSW
• Victoria M. Hominick, LCSW
• Hoosier Care (Walter Lawson Children's Home)
• Hoosier Care, Inc. (Walter Lawson Children's Home)
• Cheryl Lynn Horkheimer, LMT
• Jason Huffman, CRNA

• Orthodontics and Dentofacial Orthopedics Dentistry in Loves Park, IL
• Providers in Loves Park, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.