Provider Demographics
NPI:1003932427
Name:HOLZBACH, JOHN GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:HOLZBACH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471
Mailing Address - Country:US
Mailing Address - Phone:330-755-1458
Mailing Address - Fax:330-755-0735
Practice Address - Street 1:300 E MANOR AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471
Practice Address - Country:US
Practice Address - Phone:330-755-1458
Practice Address - Fax:330-755-0735
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist