Provider Demographics
NPI:1477937100
Name:HOLLAND, JASON (DDS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HOLLAND
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 1:5314 S YALE AVE
Mailing Address - Street 2:#1100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5314 S YALE AVE
Practice Address - Street 2:#1100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6256
Practice Address - Country:US
Practice Address - Phone:918-492-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist