Individual
DR. CORDELL W TOLLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
714 EXETER AVENUE, MIDDLESBORO, KY 40965-1461
(606) 248-5302
(606) 248-5302
Mailing address
714 EXETER AVENUE, MIDDLESBORO, KY 40965-1461
(606) 248-5302
(606) 248-5302
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4989
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0160739
BCBS TENN
TN
01
—
0688009
DELTA DENTAL
VA
05
—
60049897
—
KY
Enumeration date
09/14/2006
Last updated
12/18/2015
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