Provider Demographics
NPI:1255377925
Name:HOLMAN, JON G (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:G
Last Name:HOLMAN
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 1:13301 N MERIDIAN AVE
Mailing Address - Street 2:BLDG. 100, STE. 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9369
Mailing Address - Country:US
Mailing Address - Phone:405-486-7879
Mailing Address - Fax:
Practice Address - Street 1:13301 N MERIDIAN AVE
Practice Address - Street 2:BLDG. 100, STE. 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9369
Practice Address - Country:US
Practice Address - Phone:405-486-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7585410001Medicare PIN