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General NPI Number Information
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NPI Number | 1922627942
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Entity Type | Individual
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Provider Name | TAYLOR OGDEN BOLLAND
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Gender | Male
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 170 SMITH LN
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City | SOUTH PITTSBURG
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State | TN
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Zip | 37380-1752
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Country | US
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Telephone | 423-228-3077
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Fax |
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Provider Business Mailing Address
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Address Line | 3116 CROSSWOOD DR
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City | NASHVILLE
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State | TN
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Zip | 37214-3327
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Country | US
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Telephone | 601-968-7644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11333
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License Number State | TN
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