Healthcare Provider Details

I. General information

NPI: 1902717218
Provider Name (Legal Business Name): HOLLT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 GILMAN RD 201
DUTCH HARBOR AK
99692
US

IV. Provider business mailing address

1565 S 3150 W
VERNAL UT
84078-8739
US

V. Phone/Fax

Practice location:
  • Phone: 480-313-9172
  • Fax:
Mailing address:
  • Phone: 480-313-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MORRIE TALBOT
Title or Position: OWNER
Credential: DDS
Phone: 480-313-9172