Provider Demographics
NPI:1033879101
Name:BOLTON FAMIY DENTAL, LLP
Entity Type:Organization
Organization Name:BOLTON FAMIY DENTAL, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-779-6223
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-0309
Mailing Address - Country:US
Mailing Address - Phone:978-779-6223
Mailing Address - Fax:978-779-6479
Practice Address - Street 1:737 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1215
Practice Address - Country:US
Practice Address - Phone:978-779-6223
Practice Address - Fax:978-779-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental