Provider Demographics
NPI:1669534541
Name:HOLOVAK, JOHN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:HOLOVAK
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:PO BOX 366
Mailing Address - Street 2:1943 SMITH TOWNSHIP STATE ROAD
Mailing Address - City:SLOVAN
Mailing Address - State:PA
Mailing Address - Zip Code:15078
Mailing Address - Country:US
Mailing Address - Phone:724-947-5880
Mailing Address - Fax:724-947-9660
Practice Address - Street 1:1943 SMITH TOWNSHIP STATE ROAD
Practice Address - Street 2:
Practice Address - City:SLOVAN
Practice Address - State:PA
Practice Address - Zip Code:15078
Practice Address - Country:US
Practice Address - Phone:724-947-5880
Practice Address - Fax:724-947-9660
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA019018L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU75761Medicare UPIN