Healthcare Provider Details

I. General information

NPI: 1336054527
Provider Name (Legal Business Name): RIA LANAE HOLLOMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 DOGWOOD BLVD
KANNAPOLIS NC
28081-9461
US

IV. Provider business mailing address

KANNAPOLIS PKWY & ROGERS LAKE RD
KANNAPOLIS NC
63139
US

V. Phone/Fax

Practice location:
  • Phone: 980-471-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14932
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: