Healthcare Provider Details

I. General information

NPI: 1811773914
Provider Name (Legal Business Name): TREVOR DAVID HOLLOWAY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44274 GEORGE CUSHMAN CT STE 108
TEMECULA CA
92592-5945
US

IV. Provider business mailing address

44274 GEORGE CUSHMAN CT STE 108
TEMECULA CA
92592-5945
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-2803
  • Fax:
Mailing address:
  • Phone: 951-303-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: