Provider Demographics
NPI:1659379220
Name:VOTTELER, HOLLY MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MICHELLE
Last Name:VOTTELER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 RUCKRIEGEL PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4199
Mailing Address - Country:US
Mailing Address - Phone:502-297-8000
Mailing Address - Fax:502-297-8001
Practice Address - Street 1:3831 RUCKRIEGEL PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4199
Practice Address - Country:US
Practice Address - Phone:502-297-8000
Practice Address - Fax:502-297-8001
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7085OtherDENTAL LICENSE