Provider Demographics
NPI:1053839449
Name:HOLLOWAY, LIZANNE OLIVIA (DDS)
Entity Type:Individual
Prefix:
First Name:LIZANNE
Middle Name:OLIVIA
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N HOUSTON ST APT 2203
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7665
Mailing Address - Country:US
Mailing Address - Phone:817-301-8839
Mailing Address - Fax:
Practice Address - Street 1:900 E COPELAND RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-1392
Practice Address - Country:US
Practice Address - Phone:817-672-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist