Provider Demographics
NPI:1891582649
Name:BOLAND, EVAN VICTORIA (DMD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:VICTORIA
Last Name:BOLAND
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 HABERSHAM VLY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1496
Mailing Address - Country:US
Mailing Address - Phone:770-826-5415
Mailing Address - Fax:
Practice Address - Street 1:5715 HABERSHAM VLY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1496
Practice Address - Country:US
Practice Address - Phone:770-826-5415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program