Provider Demographics
NPI:1063498608
Name:HOLBROOK, JEROME SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:SCOTT
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:7455 EAST TANQUE VERDE ROAD
Mailing Address - Street 2:
Mailing Address - City:TUSCON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-745-2454
Mailing Address - Fax:520-745-0014
Practice Address - Street 1:7455 EAST TANQUE VERDE ROAD
Practice Address - Street 2:
Practice Address - City:TUSCON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-745-2454
Practice Address - Fax:520-745-0014
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZD43001223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery