Provider Demographics
NPI:1295426427
Name:BIGELOW, HOLDEN S (DMD)
Entity type:Individual
Prefix:
First Name:HOLDEN
Middle Name:S
Last Name:BIGELOW
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 1:430 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-1640
Mailing Address - Country:US
Mailing Address - Phone:918-789-2515
Mailing Address - Fax:
Practice Address - Street 1:430 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-1640
Practice Address - Country:US
Practice Address - Phone:918-789-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice