Provider Demographics
NPI:1134886062
Name:RYAN S. HOLBROOK, DMD, P.A.
Entity type:Organization
Organization Name:RYAN S. HOLBROOK, DMD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-484-3885
Mailing Address - Street 1:5565 NEW COVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5212
Mailing Address - Country:US
Mailing Address - Phone:574-265-9507
Mailing Address - Fax:
Practice Address - Street 1:200 CAPRI ISLES BLVD UNIT 1A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-2335
Practice Address - Country:US
Practice Address - Phone:941-484-3885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental