Provider Demographics
NPI:1104241405
Name:BUCHHOLTZ, KEVIN I (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BUCHHOLTZ
Suffix:I
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 1:1306 CLARENDON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3912
Mailing Address - Country:US
Mailing Address - Phone:336-209-0459
Mailing Address - Fax:
Practice Address - Street 1:3000 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8212
Practice Address - Country:US
Practice Address - Phone:919-739-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-23
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist