Provider Demographics
NPI:1881730992
Name:HOLLOWAY, TIMOTHY E (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
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 1:165 PRESIDENTS DR
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-8525
Mailing Address - Country:US
Mailing Address - Phone:724-238-6026
Mailing Address - Fax:
Practice Address - Street 1:2010 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1172
Practice Address - Country:US
Practice Address - Phone:724-238-6666
Practice Address - Fax:724-238-6890
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019961L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA133021OtherUNITED CONCORDIA PROVIDER