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General NPI Number Information
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NPI Number | 1760783468
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Entity Type | Organization
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Legal Business Name | BOLAND & MANNARI LLC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 6540 4TH ST N SUITE A
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City | ST PETERSBURG
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State | FL
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Zip | 33702-6822
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Country | US
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Telephone | 727-525-0155
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Fax | 727-525-0155
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Provider Business Mailing Address
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Address Line | 6540 4TH ST N SUITE A
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City | ST PETERSBURG
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State | FL
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Zip | 33702-6822
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Country | US
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Telephone | 727-525-0155
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Fax | 727-525-0155
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Authorized Official
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Title or Position | PHYSICIAN
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Name | THOMAS J BOLAND
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Credential | MD, DMD
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Telephone | 727-525-0155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | ME50633
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License Number State | FL
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