Provider Demographics
NPI:1982029526
Name:HOLBROOK, JERRI ANN (RDH, EPDH)
Entity Type:Individual
Prefix:MRS
First Name:JERRI
Middle Name:ANN
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:RDH, EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19337 WHITNEY LN
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4243
Mailing Address - Country:US
Mailing Address - Phone:503-351-5333
Mailing Address - Fax:593-655-3159
Practice Address - Street 1:19337 WHITNEY LN
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4243
Practice Address - Country:US
Practice Address - Phone:503-351-5333
Practice Address - Fax:503-655-3159
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH2015124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist