Provider Demographics
NPI:1659394773
Name:HOLDRIDGE, ROBERT E (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HOLDRIDGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W ROOSEVELT RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5086
Mailing Address - Country:US
Mailing Address - Phone:630-668-3423
Mailing Address - Fax:630-668-3436
Practice Address - Street 1:620 W ROOSEVELT RD
Practice Address - Street 2:SUITE B1
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5086
Practice Address - Country:US
Practice Address - Phone:630-668-3423
Practice Address - Fax:630-668-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice