Provider Demographics
NPI:1265544209
Name:HOLDEN, LORI CRUZ (DDS)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:CRUZ
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1505
Mailing Address - Country:US
Mailing Address - Phone:405-321-2414
Mailing Address - Fax:405-321-3835
Practice Address - Street 1:3391 CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-1505
Practice Address - Country:US
Practice Address - Phone:405-321-2414
Practice Address - Fax:405-321-3835
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200089410AMedicaid