Organization
SOUTHERN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRICK HOLYOAK (OWNER)
(630) 699-3744
Entity
Organization
Contact information
Practice address
3320 W SOUTHERN AVE STE 111, PHOENIX, AZ 85041-4307
(630) 699-3744
Mailing address
3934 E AUSTIN DR, GILBERT, AZ 85296-0711
(602) 305-8800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223D0001X
Public Health Dentistry
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
03/21/2026
Last updated
03/21/2026
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