Provider Demographics
NPI:1295719516
Name:G STEPHEN OLLARD DDS, PLLC
Entity type:Organization
Organization Name:G STEPHEN OLLARD DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:OLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-4641
Mailing Address - Street 1:6311 KINGSTON PIKE
Mailing Address - Street 2:SUITE 26W
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4906
Mailing Address - Country:US
Mailing Address - Phone:865-584-4641
Mailing Address - Fax:865-584-8199
Practice Address - Street 1:6311 KINGSTON PIKE
Practice Address - Street 2:SUITE 26W
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4906
Practice Address - Country:US
Practice Address - Phone:865-584-4641
Practice Address - Fax:865-584-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000020881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty