Provider Demographics
NPI:1790989200
Name:HOLLOMAN, ANDREW J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:HOLLOMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:HOLLOMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2127 NE COACHMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2631
Mailing Address - Country:US
Mailing Address - Phone:727-581-1441
Mailing Address - Fax:727-585-4766
Practice Address - Street 1:2127 NE COACHMAN RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2631
Practice Address - Country:US
Practice Address - Phone:727-581-1441
Practice Address - Fax:727-585-4766
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18076122300000X
OK5949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist