Provider Demographics
NPI:1376621417
Name:HOLMAN, R. GAYLE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:GAYLE
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1345 E 3900 S
Mailing Address - Street 2:STE 202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1474
Mailing Address - Country:US
Mailing Address - Phone:801-278-2819
Mailing Address - Fax:801-278-2546
Practice Address - Street 1:1345 E 3900 S
Practice Address - Street 2:STE 202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1474
Practice Address - Country:US
Practice Address - Phone:801-278-2819
Practice Address - Fax:801-278-2546
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT22137142-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics