Provider Demographics
NPI:1740973536
Name:HOLLADAY HILLS FAMILY DENTAL P.C.
Entity type:Organization
Organization Name:HOLLADAY HILLS FAMILY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-971-8884
Mailing Address - Street 1:2200 E 4500 S STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4032
Mailing Address - Country:US
Mailing Address - Phone:801-971-8884
Mailing Address - Fax:
Practice Address - Street 1:622 E 4500 S STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2922
Practice Address - Country:US
Practice Address - Phone:801-313-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty