Provider Demographics
NPI:1487224754
Name:KEVIN HOLLY DDS PLLC
Entity Type:Organization
Organization Name:KEVIN HOLLY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-738-6361
Mailing Address - Street 1:520 HIGHWAY 96 W STE 400
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-3201
Mailing Address - Country:US
Mailing Address - Phone:651-482-7564
Mailing Address - Fax:
Practice Address - Street 1:520 HIGHWAY 96 W STE 400
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-3201
Practice Address - Country:US
Practice Address - Phone:651-482-7564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty