Provider Demographics
NPI:1366989667
Name:GABRIEL B. HOLDWICK, DDS, PC
Entity type:Organization
Organization Name:GABRIEL B. HOLDWICK, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:BENEDICT
Authorized Official - Last Name:HOLDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-479-9041
Mailing Address - Street 1:415 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1210
Mailing Address - Country:US
Mailing Address - Phone:989-479-3403
Mailing Address - Fax:
Practice Address - Street 1:415 STATE ST
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1210
Practice Address - Country:US
Practice Address - Phone:989-479-3403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021464261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental