Provider Demographics
NPI:1730741323
Name:HOLOSKO, ADRIENNE R (DMD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:R
Last Name:HOLOSKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 45TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3959
Mailing Address - Country:US
Mailing Address - Phone:219-924-8766
Mailing Address - Fax:
Practice Address - Street 1:1630 45TH ST STE 104
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3959
Practice Address - Country:US
Practice Address - Phone:219-924-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-11
Deactivation Date:2019-07-03
Deactivation Code:
Reactivation Date:2019-07-11
Provider Licenses
StateLicense IDTaxonomies
IN12013231A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist