Provider Demographics
NPI:1265685176
Name:HOLLADAY CENTER DENTAL
Entity Type:Organization
Organization Name:HOLLADAY CENTER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAFEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-277-9213
Mailing Address - Street 1:2160 E 4500 S STE 3
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4499
Mailing Address - Country:US
Mailing Address - Phone:801-277-9213
Mailing Address - Fax:801-277-0956
Practice Address - Street 1:2160 E 4500 S STE 3
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4499
Practice Address - Country:US
Practice Address - Phone:801-277-9213
Practice Address - Fax:801-277-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320562261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental