Provider Demographics
NPI:1275657876
Name:HOLLOWAY, JIM D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:D
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 1:2217 OLAN MILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1891
Mailing Address - Country:US
Mailing Address - Phone:423-240-4319
Mailing Address - Fax:423-894-7790
Practice Address - Street 1:2217 OLAN MILLS DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1891
Practice Address - Country:US
Practice Address - Phone:423-240-4319
Practice Address - Fax:423-894-7790
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 0050781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice