Andrew Jon Hollomon, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00205171 Issued in CO

Practice address

620 John Paul Jones Cir
Portsmouth, VA 23708-2111

Phone

(757) 953-2711

NPI assigned

Jun 7, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1366171225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CRAWFORD ST APT 426",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237042340",
            "telephone_number": "605-214-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111",
            "telephone_number": "757-953-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOMON",
        "first_name": "ANDREW",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00205171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "andrew.j.hollomon2.mil@health.mil",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "620 John Paul Jones Cir",
            "city": "Portsmouth",
            "state": "VA",
            "country_code": "US",
            "postal_code": "237082111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Holiday House of Portsmouth, Inc.
• Holistic Farmacy Inc (Holisticare)
• Holley Family Dentistry
• James Whiteing Holley, IV, D.D.S.
• Jazmine Elizabeth Holley
• Justin Hollon, M.D.
• Ebony Marshaa Holloway
• Andrecia Colette Holmes, LCSFA
• Johnnie Holmes
• Marqurita Arlene Holmes

• Dentist in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.