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General NPI Number Information
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NPI Number | 1780661595
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Entity Type | Individual
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Provider Name | ANNELI K BOLLER DDS
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 103 NEW MEADOW RUN DR
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City | FARMINGTON
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State | PA
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Zip | 15437-1391
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Country | US
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Telephone | 845-481-7014
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Fax | 724-329-0942
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Provider Business Mailing Address
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Address Line | 103 NEW MEADOW RUN DR
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City | FARMINGTON
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State | PA
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Zip | 15437-1391
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Country | US
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Telephone | 845-481-7014
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Fax | 724-329-0942
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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 | DS-030926-L
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License Number State | PA
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