MEDICARE: SHERI BOLAY OM

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
1	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1316435472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI BOLAY OM

Provider Business Mailing Address
First Line	:	3629 NW 68TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-2015
Country	:	US
Telephone Number	:	405-840-3119
Fax Number	:

Provider Business Practice Location Address
First Line	:	3629 NW 68TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-2015
Country	:	US
Telephone Number	:	405-840-3119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	04/24/2018

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Directions to “ SHERI BOLAY OM” Practice Location

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