Provider Demographics
NPI:1558891994
Name:HOLYOAK, KENDRICK (DMD)
Entity Type:Individual
Prefix:
First Name:KENDRICK
Middle Name:
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 1:7400 W ARROWHEAD CLUBHOUSE DR APT 3063
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8832
Mailing Address - Country:US
Mailing Address - Phone:630-699-3744
Mailing Address - Fax:
Practice Address - Street 1:7400 W ARROWHEAD CLUBHOUSE DR APT 3063
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8832
Practice Address - Country:US
Practice Address - Phone:630-699-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD00097491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice