Provider Demographics
NPI:1689668501
Name:DENHOLM, EDWARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:DENHOLM
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 1:528 PORTAGE TRAIL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3230
Mailing Address - Country:US
Mailing Address - Phone:330-633-6420
Mailing Address - Fax:330-630-6420
Practice Address - Street 1:528 PORTAGE TRAIL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3230
Practice Address - Country:US
Practice Address - Phone:330-633-6420
Practice Address - Fax:330-630-6420
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13460041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice