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General NPI Number Information
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NPI Number | 1790916146
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Entity Type | Organization
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Legal Business Name | BRANT BOLING, DDS, PLLC
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 1429 CLEAR LAKE RD STE 700
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City | WEATHERFORD
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State | TX
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Zip | 76086-5805
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Country | US
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Telephone | 817-598-0835
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Fax | 817-598-0845
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Provider Business Mailing Address
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Address Line | 1429 CLEAR LAKE RD STE 700
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City | WEATHERFORD
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State | TX
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Zip | 76086-5805
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Country | US
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Telephone | 817-598-0835
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Fax | 817-598-0845
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRANT BOLING
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Credential | DDS
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Telephone | 817-598-0835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019240
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License Number State | TX
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