Provider Demographics
NPI:1639857659
Name:HOLLOWAY, DYLAN (DMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ORCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1385
Mailing Address - Country:US
Mailing Address - Phone:229-347-2396
Mailing Address - Fax:
Practice Address - Street 1:1725 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3362
Practice Address - Country:US
Practice Address - Phone:229-883-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1231591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice