NPI 1013023837

Gregory Bouldien, DDSMS

Practitioner Orthodontics and Dentofacial Orthopedics Dentistry Olive Branch, MS

Practice location

Address: 9880 Goodman Rd, Olive Branch, MS 38654-1722
Phone: (662) 470-4919
Fax: (662) 874-6295

Registered specialties

Orthodontics and Dentofacial Orthopedics Dentistry Primary

Dental Providers Taxonomy 1223X0400X Licence 5213 (TN)

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Registry record

NPI: 1013023837
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Aug 2006
Record last updated: 17 Mar 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.