Provider Demographics
NPI:1801964838
Name:HOLLOSZY, FREDERIC G II (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:G
Last Name:HOLLOSZY
Suffix:II
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 1:100 ARCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1381
Mailing Address - Country:US
Mailing Address - Phone:650-367-1225
Mailing Address - Fax:650-367-1226
Practice Address - Street 1:100 ARCH ST STE 4
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1381
Practice Address - Country:US
Practice Address - Phone:650-367-1225
Practice Address - Fax:650-367-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18945089OtherEDD ACCOUNT NUMBER
CA17933OtherLICENSE