Provider Demographics
NPI:1649618422
Name:HOLDERBAUM, WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:HOLDERBAUM
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 1:1870 DUBLIN BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1294
Mailing Address - Country:US
Mailing Address - Phone:719-528-8282
Mailing Address - Fax:719-528-8286
Practice Address - Street 1:1870 DUBLIN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1294
Practice Address - Country:US
Practice Address - Phone:719-528-8282
Practice Address - Fax:719-528-8286
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist