Individual
DR. WILLIAM TILDEN BOLAND III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5700 OLD RICHMOND AVENUE, SUITE D15, RICHMOND, VA 23226-1828
(804) 288-4103
(804) 288-4505
Mailing address
5700 OLD RICHMOND AVENUE, SUITE D15, RICHMOND, VA 23226-1828
(804) 288-4103
(804) 288-4505
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007800
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101562
ANTHEM
—
01
—
783066
UNITED CONCORDIA
—
Enumeration date
09/01/2006
Last updated
07/08/2007
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