Provider Demographics
NPI:1225058977
Name:HOLLOWAY, RAY A (DDS)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:A
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 1:111 W 16TH AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-6206
Mailing Address - Country:US
Mailing Address - Phone:907-561-1430
Mailing Address - Fax:907-561-2697
Practice Address - Street 1:111 W 16TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-6206
Practice Address - Country:US
Practice Address - Phone:907-561-1430
Practice Address - Fax:907-561-2697
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD8638Medicaid
AKDD86381Medicaid
AK1518402OtherTRI CARE PROVIDER ID