Provider Demographics
NPI:1437460185
Name:HOLYOAK, BRANDON JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JEFFREY
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 1:314 E ALBENI HWY
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856-9207
Mailing Address - Country:US
Mailing Address - Phone:208-448-2694
Mailing Address - Fax:
Practice Address - Street 1:314 E ALBENI HWY
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-9207
Practice Address - Country:US
Practice Address - Phone:208-448-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4307122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist