Provider Demographics
NPI:1033261839
Name:HOLTHAUS, RICHARD L (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:HOLTHAUS
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 1:3418 N HIGHWAY F
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0737
Mailing Address - Country:US
Mailing Address - Phone:608-757-5000
Mailing Address - Fax:608-757-5010
Practice Address - Street 1:3418 HIGHWAY F
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0737
Practice Address - Country:US
Practice Address - Phone:608-757-5000
Practice Address - Fax:608-757-5010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-08-21
Deactivation Date:2007-08-30
Deactivation Code:
Reactivation Date:2009-07-29
Provider Licenses
StateLicense IDTaxonomies
WI1305G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice