Active NPI
Jared Holloway, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Anoka, MN
National Provider Identifier
1720548787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- S239
- Practice address
- 3507 Round Lake Blvd NW
Anoka, MN 55303-5001 - Phone
- (763) 323-7677
- NPI assigned
- Mar 24, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 112057379921 | UT | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | S239 | MN | Primary |
Addresses
Primary practice location
3507 Round Lake Blvd NW
Anoka, MN 55303-5001
Mailing address
3507 Round Lake Blvd NW
Anoka, MN 55303-5001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112057379921 | UT | MD | Dentist |
| S239 | MN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752105600000",
"number": "1720548787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3507 ROUND LAKE BLVD NW",
"city": "ANOKA",
"state": "MN",
"postal_code": "553035001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3507 ROUND LAKE BLVD NW",
"city": "ANOKA",
"state": "MN",
"postal_code": "553035001",
"telephone_number": "763-323-7677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "JARED",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-24",
"last_updated": "2025-07-10",
"certification_date": "2025-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "112057379921",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MN",
"license": "S239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.