MEDICARE: DR. BEAU BOLDING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	62214	KS
2	1223G0001X	General Practice Dentistry	4294-22	MS
3	390200000X	Student in an Organized Health Care Education/Training Program
4	1223G0001X	General Practice Dentistry	11954	TN

General Provider Information

NPI Number	:	1659028652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEAU BOLDING DDS

Provider Business Mailing Address
First Line	:	1300 HATCHER LN STE 1
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3554
Country	:	US
Telephone Number	:	931-388-2279
Fax Number	:	931-223-5567

Provider Business Practice Location Address
First Line	:	1300 HATCHER LN STE 1
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3554
Country	:	US
Telephone Number	:	931-388-2279
Fax Number	:	931-223-5567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	08/12/2025

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