Provider Demographics
NPI:1144517582
Name:HOLLICK, BRIDGETT SABAT (DDS)
Entity type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:SABAT
Last Name:HOLLICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BRIDGETT
Other - Middle Name:
Other - Last Name:SABAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:1670 W RUTHRAUFF RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1253
Practice Address - Country:US
Practice Address - Phone:520-616-6200
Practice Address - Fax:520-682-1087
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0090621223G0001X
CA604601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ066556Medicaid