Provider Demographics
NPI:1407167992
Name:HOLYOAK, JEFFERY REID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:REID
Last Name:HOLYOAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 NW 179TH CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0669
Mailing Address - Country:US
Mailing Address - Phone:405-503-7593
Mailing Address - Fax:
Practice Address - Street 1:9405 N PENNSYLVANIA PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3801
Practice Address - Country:US
Practice Address - Phone:405-753-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist