Provider Demographics
NPI:1225145550
Name:HOLLOWAY, ROBERT LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
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:PO BOX 1173
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46061
Mailing Address - Country:US
Mailing Address - Phone:317-773-0278
Mailing Address - Fax:317-773-2203
Practice Address - Street 1:1104 CONNER ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2808
Practice Address - Country:US
Practice Address - Phone:317-773-0278
Practice Address - Fax:317-773-2203
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist