Healthcare Provider Details

I. General information

NPI: 1952056699
Provider Name (Legal Business Name): JACQUELINE YI BOLLINGER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S HIGLEY RD STE 116
GILBERT AZ
85296-4789
US

IV. Provider business mailing address

1355 S HIGLEY RD STE 116
GILBERT AZ
85296-4789
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-4120
  • Fax:
Mailing address:
  • Phone: 480-545-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD012405
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: