Provider Demographics
NPI:1821402900
Name:HOLPUCH, ANDREW S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:HOLPUCH
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 1:8143 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:
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:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0242251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice