Healthcare Provider Details

I. General information

NPI: 1760783468
Provider Name (Legal Business Name): BOLAND & MANNARI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 08/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 4TH ST N SUITE A
ST PETERSBURG FL
33702-6822
US

IV. Provider business mailing address

6540 4TH ST N SUITE A
ST PETERSBURG FL
33702-6822
US

V. Phone/Fax

Practice location:
  • Phone: 727-525-0155
  • Fax: 727-525-0155
Mailing address:
  • Phone: 727-525-0155
  • Fax: 727-525-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME50633
License Number StateFL

VIII. Authorized Official

Name: THOMAS J BOLAND
Title or Position: PHYSICIAN
Credential: MD, DMD
Phone: 727-525-0155