MEDICARE: DR. DAVID T BOLGER DMD

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
1	122300000X	Dentist	22DI01565400	NJ

General Provider Information

NPI Number	:	1770548240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID T BOLGER DMD

Provider Business Mailing Address
First Line	:	6816 VENTNOR AE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406
Country	:	US
Telephone Number	:	609-823-6100
Fax Number	:	609-823-4336

Provider Business Practice Location Address
First Line	:	6816 VENTNOR AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406
Country	:	US
Telephone Number	:	609-823-6100
Fax Number	:	609-823-4336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	11/07/2017

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