Provider Demographics
NPI:1588083711
Name:HOLLEMAN, TREVOR (DDS)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:HOLLEMAN
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 1:1700 S SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3227
Mailing Address - Country:US
Mailing Address - Phone:605-331-5059
Mailing Address - Fax:605-275-6725
Practice Address - Street 1:1700 S SOUTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103
Practice Address - Country:US
Practice Address - Phone:605-331-5059
Practice Address - Fax:605-275-6725
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD12001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery