Provider Demographics
NPI:1336347152
Name:BOLAND, ROBERT KENT (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENT
Last Name:BOLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 72ND STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1820
Mailing Address - Country:US
Mailing Address - Phone:816-436-5405
Mailing Address - Fax:816-436-6388
Practice Address - Street 1:200 NW 72ND STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1820
Practice Address - Country:US
Practice Address - Phone:816-436-5405
Practice Address - Fax:816-436-6388
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist