Provider Demographics
NPI:1528293255
Name:HOLDAWAY, GAYLAN CHRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:GAYLAN
Middle Name:CHRIS
Last Name:HOLDAWAY
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 1:3325 N TEN MILE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6951
Mailing Address - Country:US
Mailing Address - Phone:336-509-0278
Mailing Address - Fax:855-204-6128
Practice Address - Street 1:3325 N TEN MILE RD # 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5409
Practice Address - Country:US
Practice Address - Phone:208-228-5499
Practice Address - Fax:855-204-6128
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8766122300000X
IDD-4798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist