Provider Demographics
NPI:1669527180
Name:HOLYOAK FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:HOLYOAK FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOLYOAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-993-0670
Mailing Address - Street 1:12414 N 28TH DRIVE SUITE #A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-993-0670
Mailing Address - Fax:602-993-0683
Practice Address - Street 1:12414 N 28TH DRIVE SUITE #A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-993-0670
Practice Address - Fax:602-993-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty