Healthcare Provider Details

I. General information

NPI: 1093599102
Provider Name (Legal Business Name): MICHAEL HOLLAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 HOEN AVE STE 6
SANTA ROSA CA
95405-7830
US

IV. Provider business mailing address

4655 HOEN AVE STE 6
SANTA ROSA CA
95405-7830
US

V. Phone/Fax

Practice location:
  • Phone: 707-545-5260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number109952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: