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NPI Code Detail

MEDICARE: BOLEN DENTAL PC

MEDICARE: BOLEN DENTAL PC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1659962595
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOLEN DENTAL PC
Provider Business Mailing Address
First Line : 141 N 5TH ST
Second Line :
City : CUSTER
State : SD
Zip : 57730-1528
Country : US
Telephone Number : 605-261-6488
Fax Number :
Provider Business Practice Location Address
First Line : 141 N 5TH ST
Second Line :
City : CUSTER
State : SD
Zip : 57730-1528
Country : US
Telephone Number : 605-321-2086
Fax Number :
Authorized Official
Title or Position : PRESIDENT BOLEN DENTAL PC
Name : DR. KARI BOLEN
Credential : DDS
Telephone Number : 605-261-6488
Provider Enumeration Date : 02/02/2021
Last Update Date : 05/06/2021

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Directions to “BOLEN DENTAL PC ” Practice Location

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