Individual provider Active NPI

Dennis Holloway III, DDS

  • Dentist
  • Canton, MS
National Provider Identifier
1639236763
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2733 93 Issued in MS
Practice address
1668 W Peace St
Canton, MS 39046-5332
Phone
(601) 859-5213
Fax
(601) 859-8771
NPI assigned
Jan 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2733 93 MS Primary

Addresses

Primary practice location

1668 W Peace St
Canton, MS 39046-5332

Mailing address

PO Box 588
Canton, MS 39046-0588
Phone (601) 859-5213

Other identifiers 1

IdentifierTypeStateIssuer
00660065MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20200609001448 MS Order and Referring Only - DentistPractitioner - Dentist 1850712308

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2733 93MSMDDentist

Interoperability endpoints

  • Direct secure messaging: dennis.holloway@fhcc.eclinicaldirectplus.com

NPI Registry JSON

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639236763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 588",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390460588",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1668 W PEACE ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390465332",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "DENNIS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "2733 93",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00660065",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MS

Sources for this page

Verify at the official NPI Registry.