Provider Demographics
NPI:1144408170
Name:WILLIAM T. BOLAND, DMD
Entity Type:Organization
Organization Name:WILLIAM T. BOLAND, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ARCHER
Authorized Official - Last Name:LUKOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-288-4103
Mailing Address - Street 1:5700 OLD RICHMOND AVE
Mailing Address - Street 2:SUITE D-15
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1828
Mailing Address - Country:US
Mailing Address - Phone:804-288-4103
Mailing Address - Fax:804-288-4505
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:SUITE D-15
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-288-4103
Practice Address - Fax:804-288-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty