Provider Demographics
NPI:1790820637
Name:HOLDAWAY, CRAIG TAYLOR (DDS MSD PC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:TAYLOR
Last Name:HOLDAWAY
Suffix:
Gender:M
Credentials:DDS MSD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 EDGEWOOD DR UNIT 109
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7742
Mailing Address - Country:US
Mailing Address - Phone:801-224-5931
Mailing Address - Fax:
Practice Address - Street 1:5005 EDGEWOOD DR UNIT 109
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7742
Practice Address - Country:US
Practice Address - Phone:801-224-5931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics