Healthcare Provider Details

I. General information

NPI: 1285049288
Provider Name (Legal Business Name): JOHN STEPHEN BOLING DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 WEST ST STE 320
GERMANTOWN TN
38138-3859
US

IV. Provider business mailing address

2887 BELFORT DR
GERMANTOWN TN
38138-7330
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-3878
  • Fax:
Mailing address:
  • Phone: 870-219-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9809
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3910
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: