Provider Demographics
NPI:1841393253
Name:HOLLOMAN, IRENE MARGARET (DDS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARGARET
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:STANGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:229 DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229 DENVER AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621
Practice Address - Country:US
Practice Address - Phone:303-857-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1042671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice