Provider Demographics
NPI:1265656938
Name:HOLYOAK, ROBERT S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:HOLYOAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9431 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4237
Mailing Address - Country:US
Mailing Address - Phone:623-933-8410
Mailing Address - Fax:
Practice Address - Street 1:9431 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4237
Practice Address - Country:US
Practice Address - Phone:623-933-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice