Active NPI
Ray A. Holloway, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Anchorage, AK
National Provider Identifier
1225058977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 1077
- Practice address
- 111 W 16TH Ave
Suite 203
Anchorage, AK 99501-6206 - Phone
- (907) 561-1430
- Fax
- (907) 561-2697
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 1077 | AK | Primary |
Addresses
Primary practice location
111 W 16TH Ave
Suite 203
Anchorage, AK 99501-6206
Mailing address
111 W 16TH Ave
Ste 203
Anchorage, AK 99501-6206
Phone (907) 561-1430
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD8638 | Medicaid | AK | |
| DD86381 | Medicaid | AK | |
| 1518402 | Other | AK | TRI CARE PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 16, 2014 through Jun 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1077 | AK | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207785600000",
"number": "1225058977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 W 16TH AVE",
"address_2": "STE 203",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995016206",
"telephone_number": "907-561-1430",
"fax_number": "907-561-2697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 W 16TH AVE",
"address_2": "SUITE 203",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995016206",
"telephone_number": "907-561-1430",
"fax_number": "907-561-2697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "RAY",
"middle_name": "A.",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2008-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "AK",
"license": "1077",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD8638",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD86381",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRI CARE PROVIDER ID",
"identifier": "1518402",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.