Provider Demographics
NPI:1447311311
Name:ROLLAR, THOMAS F JR
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:ROLLAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SINGLETON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526
Mailing Address - Country:US
Mailing Address - Phone:843-347-2900
Mailing Address - Fax:843-347-2906
Practice Address - Street 1:630 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-347-2900
Practice Address - Fax:843-347-2906
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990018Medicaid
SCZA9692Medicaid
NC8990018Medicaid