Individual
DR. GREGORY BOULDIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
9880 GOODMAN RD, OLIVE BRANCH, MS 38654-1722
(662) 470-4919
(662) 874-6295
Mailing address
9880 GOODMAN RD, OLIVE BRANCH, MS 38654-1722
(662) 470-4919
(662) 874-6295
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5213
TN
Other
Enumeration date
08/22/2006
Last updated
03/17/2018
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