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General NPI Number Information
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NPI Number | 1881620672
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Entity Type | Individual
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Provider Name | ALJERNON JOHN BOLDEN DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 801 S PAULINA ST
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City | CHICAGO
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State | IL
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Zip | 60612-7210
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Country | US
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Telephone | 312-996-0406
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Fax | 312-996-0178
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Provider Business Mailing Address
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Address Line | 1455 W CUYLER AVE # 1E
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City | CHICAGO
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State | IL
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Zip | 60613-1917
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Country | US
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Telephone | 773-348-3583
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Fax | 773-348-3615
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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 | 13698
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License Number State | MA
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