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NPI Code Detail

MEDICARE: DR. COOPER FRANCIS BOLAK DDS

MEDICARE: DR. COOPER FRANCIS BOLAK DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry8407CO
21223G0001XGeneral Practice Dentistry25944TX
31223G0001XGeneral Practice DentistryDE60350473WA

General Provider Information

NPI Number : 1174524995
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COOPER FRANCIS BOLAK DDS
Provider Business Mailing Address
First Line : 4722 FAUNTLEROY WAY SW STE A
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4667
Country : US
Telephone Number : 206-928-6242
Fax Number :
Provider Business Practice Location Address
First Line : 4722 FAUNTLEROY WAY SW STE A
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4667
Country : US
Telephone Number : 206-928-6242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 10/26/2022

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Directions to “ DR. COOPER FRANCIS BOLAK DDS” Practice Location

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