Provider Demographics
NPI:1013017102
Name:HOLPUCH, RUSSELL C (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:HOLPUCH
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 EUREKA WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0230
Mailing Address - Country:US
Mailing Address - Phone:530-241-3302
Mailing Address - Fax:530-241-3321
Practice Address - Street 1:2710 EUREKA WAY STE 5
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0230
Practice Address - Country:US
Practice Address - Phone:530-241-3302
Practice Address - Fax:530-241-3321
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics