Healthcare Provider Details

I. General information

NPI: 1669590618
Provider Name (Legal Business Name): STEVEN EDWARD HOLBROOK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8228 LOUISIANA BLVD NE STE C
ALBUQUERQUE NM
87113-2427
US

IV. Provider business mailing address

8228 LOUISIANA BLVD NE STE C
ALBUQUERQUE NM
87113-2427
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-1159
  • Fax: 505-881-9520
Mailing address:
  • Phone: 505-881-1159
  • Fax: 505-881-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1525
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: