Provider Demographics
NPI:1255410817
Name:HENRY R. BOLLINGER, III, DDS, PC
Entity type:Organization
Organization Name:HENRY R. BOLLINGER, III, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLINGER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-355-4140
Mailing Address - Street 1:11897 BENHAM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1300
Mailing Address - Country:US
Mailing Address - Phone:314-355-4140
Mailing Address - Fax:314-355-7897
Practice Address - Street 1:11897 BENHAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1300
Practice Address - Country:US
Practice Address - Phone:314-355-4140
Practice Address - Fax:314-355-7897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty