Healthcare Provider Details

I. General information

NPI: 1720105679
Provider Name (Legal Business Name): NANCY N BOLT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N GREEN ST
BROWNSBURG IN
46112-1022
US

IV. Provider business mailing address

PO BOX 196
BROWNSBURG IN
46112-0196
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-7112
  • Fax: 810-815-1715
Mailing address:
  • Phone: 317-852-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008249A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: