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General NPI Number Information
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NPI Number | 1720410806
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Entity Type | Individual
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Provider Name | JODI SHANNON BOLING D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 2704 E NETTLETON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-4529
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Country | US
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Telephone | 870-932-9886
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 E NETTLETON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-4529
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Country | US
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Telephone | 870-932-9886
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 3950
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License Number State | AR
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