Provider Demographics
NPI:1114403995
Name:BOLDBAATAR, ALIMAA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIMAA
Middle Name:
Last Name:BOLDBAATAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4445
Mailing Address - Country:US
Mailing Address - Phone:661-328-0876
Mailing Address - Fax:661-327-4733
Practice Address - Street 1:1705 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4445
Practice Address - Country:US
Practice Address - Phone:661-328-0876
Practice Address - Fax:661-327-4733
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist