Provider Demographics
NPI:1619348653
Name:ANDREW S HOLPUCH DDS, PHD, INC
Entity Type:Organization
Organization Name:ANDREW S HOLPUCH DDS, PHD, INC
Other - Org Name:GARRETTSVILLE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HOLPUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:330-527-4313
Mailing Address - Street 1:8143 WINDHAM ST
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-1112
Mailing Address - Country:US
Mailing Address - Phone:330-527-4313
Mailing Address - Fax:330-527-4314
Practice Address - Street 1:8143 WINDHAM ST
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-1112
Practice Address - Country:US
Practice Address - Phone:330-527-4313
Practice Address - Fax:330-527-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024225261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental