Provider Demographics
NPI:1083053623
Name:CORRELL, HOLDEN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLDEN
Middle Name:L
Last Name:CORRELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SW GAGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2098
Mailing Address - Country:US
Mailing Address - Phone:785-271-7477
Mailing Address - Fax:785-271-0155
Practice Address - Street 1:1107 SW GAGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2098
Practice Address - Country:US
Practice Address - Phone:785-969-6531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist