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NPI Code Detail

MEDICARE: DR. RUTH WAUQUA BOL DDS

MEDICARE: DR. RUTH WAUQUA BOL DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDE00009723WA
21223P0221XPediatric Dentistry10407TN
31223P0221XPediatric Dentistry51668CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124246376
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUTH WAUQUA BOL DDS
Provider Business Mailing Address
First Line : 1601 PRECISION PARK LN
Second Line :
City : SAN DIEGO
State : CA
Zip : 92173-1345
Country : US
Telephone Number : 619-662-4100
Fax Number :
Provider Business Practice Location Address
First Line : 4004 BEYER BLVD
Second Line :
City : SAN YSIDRO
State : CA
Zip : 92173-2099
Country : US
Telephone Number : 619-662-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 05/24/2024

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