Provider Demographics
NPI:1376974634
Name:HOLGUIN, P ANETH (RDH)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:ANETH
Last Name:HOLGUIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:PETRA
Other - Middle Name:A
Other - Last Name:HOLGUIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:4015 S AMBER ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85735-5218
Mailing Address - Country:US
Mailing Address - Phone:520-240-4348
Mailing Address - Fax:
Practice Address - Street 1:1530 W COMMERCE CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6015
Practice Address - Country:US
Practice Address - Phone:520-770-2700
Practice Address - Fax:520-889-0415
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH4885124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist