Provider Demographics
NPI:1083627509
Name:HOLLOWELL, ASHLEY D (DDM)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:D
Last Name:HOLLOWELL
Suffix:
Gender:M
Credentials:DDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 E PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4520
Mailing Address - Country:US
Mailing Address - Phone:601-859-2271
Mailing Address - Fax:601-859-2271
Practice Address - Street 1:148 E PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4520
Practice Address - Country:US
Practice Address - Phone:601-859-2271
Practice Address - Fax:601-859-2271
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3192011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660438Medicaid