Provider Demographics
NPI:1962646489
Name:HOLLOWAY, DEAN ALLEN (IDMT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:ALLEN
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 N HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9606
Mailing Address - Country:US
Mailing Address - Phone:801-586-9693
Mailing Address - Fax:
Practice Address - Street 1:3721 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9606
Practice Address - Country:US
Practice Address - Phone:801-586-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other