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General NPI Number Information
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NPI Number | 1134886062
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Entity Type | Organization
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Legal Business Name | RYAN S. HOLBROOK, DMD, P.A.
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Dates
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Enumeration Date | 11/28/2021
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 200 CAPRI ISLES BLVD UNIT 1A
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City | VENICE
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State | FL
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Zip | 34292-2335
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Country | US
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Telephone | 941-484-3885
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 NEW COVINGTON DR
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City | SARASOTA
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State | FL
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Zip | 34233-5212
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Country | US
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Telephone | 574-265-9507
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RYAN HOLBROOK
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Credential | DMD
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Telephone | 941-484-3885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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