1144517582 NPI number — BRIDGETT SABAT HOLLICK DDS

Table of content: BRIDGETT SABAT HOLLICK DDS (NPI 1144517582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144517582 NPI number — BRIDGETT SABAT HOLLICK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLICK
Provider First Name:
BRIDGETT
Provider Middle Name:
SABAT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SABAT
Provider Other First Name:
BRIDGETT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144517582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARANA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85653-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-682-4111
Provider Business Mailing Address Fax Number:
520-818-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 W RUTHRAUFF RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85705-1253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-616-6200
Provider Business Practice Location Address Fax Number:
520-682-1087
Provider Enumeration Date:
07/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D009062 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 60460 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 066556 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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