Provider Demographics
NPI:1093095432
Name:JAMES M. ROLLINS, D.D.S.,P.C.
Entity type:Organization
Organization Name:JAMES M. ROLLINS, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-824-9774
Mailing Address - Street 1:P.O. BOX 1157
Mailing Address - Street 2:394 WEST MAIN STREET B-3
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3348
Mailing Address - Country:US
Mailing Address - Phone:615-824-9774
Mailing Address - Fax:615-826-1693
Practice Address - Street 1:394 WEST MAIN STREET B-3
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3348
Practice Address - Country:US
Practice Address - Phone:615-824-9774
Practice Address - Fax:615-826-1693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES M. ROLLINS, D.D.S.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS002500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3217959Medicaid
TN2004830OtherBLUE CROSS