Provider Demographics
NPI:1386707461
Name:HOLLOWAY, THOMAS LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LYNN
Last Name:HOLLOWAY
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 1:15601 RAILROAD STREET
Mailing Address - Street 2:WOODLAND CT STE 303
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843
Mailing Address - Country:US
Mailing Address - Phone:715-634-4444
Mailing Address - Fax:
Practice Address - Street 1:15601 RAILROAD ST
Practice Address - Street 2:WOODLAND CT STE 303
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843
Practice Address - Country:US
Practice Address - Phone:715-634-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist