Provider Demographics
NPI:1386859569
Name:WILLIAM B. HOLBROOK DMD PA
Entity Type:Organization
Organization Name:WILLIAM B. HOLBROOK DMD PA
Other - Org Name:HOLBROOK DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-796-3931
Mailing Address - Street 1:401 HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2044
Mailing Address - Country:US
Mailing Address - Phone:352-796-3931
Mailing Address - Fax:352-796-2861
Practice Address - Street 1:401 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2044
Practice Address - Country:US
Practice Address - Phone:352-796-3931
Practice Address - Fax:352-796-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 78681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty