Provider Demographics
NPI:1477512853
Name:ELLENBERGER, HOLLY VOKOUN (DMD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:VOKOUN
Last Name:ELLENBERGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:WEGENER
Other - Last Name:VOKOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2405B SUNDOG CT
Mailing Address - Street 2:
Mailing Address - City:EIELSON AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99702-3102
Mailing Address - Country:US
Mailing Address - Phone:614-245-0235
Mailing Address - Fax:
Practice Address - Street 1:2630 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99702-2325
Practice Address - Country:US
Practice Address - Phone:907-377-6744
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0208311223G0001X
KY71501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice