Provider Demographics
NPI:1811556707
Name:HOLOVNIA, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HOLOVNIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 N AKARD ST APT 2811
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4481
Mailing Address - Country:US
Mailing Address - Phone:952-237-1390
Mailing Address - Fax:
Practice Address - Street 1:445 S DENTON TAP RD STE 110
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3368
Practice Address - Country:US
Practice Address - Phone:727-849-4246
Practice Address - Fax:972-393-6876
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24292122300000X
TX360801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist