Provider Demographics
NPI:1477120038
Name:HOLSBEKE, CORRINE (DDS)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:HOLSBEKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66340 OMO RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48050-1526
Mailing Address - Country:US
Mailing Address - Phone:586-719-6480
Mailing Address - Fax:
Practice Address - Street 1:47 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1315
Practice Address - Country:US
Practice Address - Phone:810-679-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016009871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice