MEDICARE: HOLLADAY HILLS FAMILY DENTAL P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1740973536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLADAY HILLS FAMILY DENTAL P.C.

Provider Business Mailing Address
First Line	:	2200 E 4500 S STE 100
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4032
Country	:	US
Telephone Number	:	801-971-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 E 4500 S STE 101
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2922
Country	:	US
Telephone Number	:	801-313-1800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON SKINNER
Credential	:	DDS
Telephone Number	:	801-971-8884

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	08/16/2023

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Directions to “HOLLADAY HILLS FAMILY DENTAL P.C. ” Practice Location

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