Provider Demographics
NPI:1780033597
Name:BOLING, MCKENZIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MCKENZIE
Middle Name:
Last Name:BOLING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 DAYCO DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-6733
Mailing Address - Country:US
Mailing Address - Phone:423-618-7754
Mailing Address - Fax:
Practice Address - Street 1:7333 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2627
Practice Address - Country:US
Practice Address - Phone:423-822-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist