Michael Kenneth Holler, D.M.D

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

64187 Issued in CA

Practice address

720 23Rd Ave BLDG 914
Port Hueneme, CA 93043-4312

Phone

(805) 982-5584

NPI assigned

Jan 7, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coppin & Lane, PLLC

  • Periodontics
  • Olympia, WA
  • NPI 1528756152
  NPD (past)
• Donald G. Echols

  • Ambulatory Surgical Clinic/Center
  • Olympia, WA
  • NPI 1710243514
  NPD (past)

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1457598849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 23RD AVE BLDG 914",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930434312",
            "telephone_number": "805-982-5584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 23RD AVE BLDG 914",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930434312",
            "telephone_number": "805-982-5584"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "128 Lilly Rd NE Ste 105",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985067400",
            "country_code": "US",
            "telephone_number": "360-357-9880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLER",
        "first_name": "MICHAEL",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-07",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "64187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Haaseth
• Shadi Haddadin
• Andrew Tyson Hammond, I.D.C
• Mark Kevin Harney, PH.D.
• David Roger Heglin, IDC
• Lamar Alan Hooper
• Taj-Zsa Marie Hower
• Hueneme Elementary School District
• Rana Ibrahim
• Geoffrey Samuel Jacoby, MD

• Periodontics in Port Hueneme, CA
• Providers in Port Hueneme, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.

Verify at the official NPI Registry.