Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 9370 | AZ |
NPI | 1083995633 |
---|---|
Provider Name | Dr. Ryan Sorbonne Holbrook |
First Address | Tempe, AZ 85283-3268 |
Second Address | Tempe, AZ 85283-3268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 19/10/2016 |