Provider Demographics
NPI:1043914781
Name:BOLIN, TAMMY TOY (RDH)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:TOY
Last Name:BOLIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 COLOR CT
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-9403
Mailing Address - Country:US
Mailing Address - Phone:931-510-2086
Mailing Address - Fax:
Practice Address - Street 1:2623 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2808
Practice Address - Country:US
Practice Address - Phone:931-484-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6898124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist