Provider Demographics
NPI:1942334016
Name:HOLOVACK, ROBERT NEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEIL
Last Name:HOLOVACK
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 1:4855 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-3137
Mailing Address - Country:US
Mailing Address - Phone:706-868-8308
Mailing Address - Fax:
Practice Address - Street 1:2176 MACLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-5190
Practice Address - Country:US
Practice Address - Phone:770-445-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist