NPIMap

Organization Active NPI

Kevin Holly DDS PLLC

  • General Practice Dentistry
  • Shoreview, MN
National Provider Identifier
1487224754
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KEVIN HOLLY DDS PLLC
Practice address
520 Highway 96 W Ste 400
Shoreview, MN 55126-3201
Phone
(651) 482-7564
NPI assigned
Jun 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Kevin Holly, DDSNPI 1407383037
Title
President
Phone
(608) 738-6361

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

520 Highway 96 W Ste 400
Shoreview, MN 55126-3201

Mailing address

520 Highway 96 W Ste 400
Shoreview, MN 55126-3201
Phone (651) 482-7564

National Provider Directory

National Provider Directory

Locations

520 Highway 96 W
Ste 400
Shoreview, MN 55126
Phone (651) 482-7564

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1487224754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 HIGHWAY 96 W STE 400",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551263201",
            "telephone_number": "651-482-7564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 HIGHWAY 96 W STE 400",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551263201",
            "telephone_number": "651-482-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN HOLLY DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "HOLLY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-738-6361",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.