Healthcare Provider Details

I. General information

NPI: 1447424148
Provider Name (Legal Business Name): KURT WILLIAM HOLLWEG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22905 W. MAIN ST
ARMADA MI
48005
US

IV. Provider business mailing address

22905 WEST MAIN STREET BOX 571
ARMADA MI
48005
US

V. Phone/Fax

Practice location:
  • Phone: 586-784-9033
  • Fax: 586-785-5644
Mailing address:
  • Phone: 586-784-9033
  • Fax: 586-784-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901009752
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: