Individual
DR. BLAKE LEWIS TOLLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MSD
Contact information
Practice address
20 CREEKVIEW CT STE A, GREENVILLE, SC 29615-4800
(864) 329-1971
(864) 329-1973
Mailing address
20 CREEKVIEW CT STE A, GREENVILLE, SC 29615-4800
(864) 329-1971
(864) 329-1973
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8950
SC
122300000X
Dentist
D.6883-C1
AL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
10920
SC
Other
Enumeration date
02/22/2017
Last updated
05/12/2025
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