Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2088 | TN |
NPI | 1063596732 |
---|---|
Provider Name | Dr. G Stephen Ollard |
First Address | Knoxville, TN 37919-4906 |
Second Address | Knoxville, TN 37919-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |