Provider Demographics
NPI:1649444555
Name:LORI HOLDEN
Entity type:Organization
Organization Name:LORI HOLDEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-321-2414
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200089410AMedicaid