Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1222527 | UT |
NPI | 1164050860 |
---|---|
Provider Name | Paige Holbrook |
First Address | Salt Lake City, UT 84108-1213 |
Second Address | Taylorsville, UT 84129-2822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2020 |
Last Update Date | 28/10/2021 |