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General NPI Number Information
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NPI Number | 1568559532
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Entity Type | Individual
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Provider Name | ELLEN CLEARY BOLLMEIER DMD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 2010 WEST HIGHWAY 50
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City | O FALLON
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State | IL
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Zip | 62269
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Country | US
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Telephone | 618-622-8888
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Fax | 618-622-9888
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Provider Business Mailing Address
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Address Line | 1237 TANGLEWOOD TRCE
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City | O FALLON
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State | IL
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Zip | 62269-3112
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Country | US
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Telephone | 618-624-6001
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Fax | 618-624-6001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-018613
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License Number State | IL
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