Provider Demographics
NPI:1063703932
Name:KAUFHOLZ, THOMAS ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:KAUFHOLZ
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 1:4550 BELDEN VILLAGE ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2524
Mailing Address - Country:US
Mailing Address - Phone:330-499-4600
Mailing Address - Fax:330-491-8179
Practice Address - Street 1:4550 BELDEN VILLAGE ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2524
Practice Address - Country:US
Practice Address - Phone:330-499-4600
Practice Address - Fax:330-491-8179
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.016829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist