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General NPI Number Information
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NPI Number | 1508476409
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Entity Type | Organization
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Legal Business Name | HOLPUCH DENTAL INC
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 340 RIDGE RD STE 2
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City | NEWTON FALLS
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State | OH
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Zip | 44444-1264
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Country | US
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Telephone | 330-872-5771
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Fax |
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Provider Business Mailing Address
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Address Line | 340 RIDGE RD STE 2
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City | NEWTON FALLS
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State | OH
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Zip | 44444-1264
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW HOLPUCH
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Credential | DDS
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Telephone | 330-872-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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