Provider Demographics
NPI:1578745857
Name:HOLLOMAN, MATTHEW JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:HOLLOMAN
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 1:218 E 10TH STREET PLZ
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4737
Mailing Address - Country:US
Mailing Address - Phone:405-341-7046
Mailing Address - Fax:405-341-6556
Practice Address - Street 1:218 E 10TH STREET PLZ
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4737
Practice Address - Country:US
Practice Address - Phone:405-341-7046
Practice Address - Fax:405-341-6556
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice