Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 35270 | CA |
NPI | 1013017102 |
---|---|
Provider Name | Dr. Russell C. Holpuch |
First Address | Redding, CA 96001-0230 |
Second Address | Redding, CA 96001-0230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |