Provider Demographics
NPI:1588143408
Name:HOLLOWAY, MARISSA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 W 29TH AVE UNIT 3157
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-7103
Mailing Address - Country:US
Mailing Address - Phone:623-340-3800
Mailing Address - Fax:
Practice Address - Street 1:950 E HARVARD AVE STE 120
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7007
Practice Address - Country:US
Practice Address - Phone:303-471-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002036771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice