Provider Demographics
NPI:1114418654
Name:BOLINGER DENTAL L.L.C.
Entity Type:Organization
Organization Name:BOLINGER DENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-456-6073
Mailing Address - Street 1:5800 FAIRFIELD AVE.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-3417
Mailing Address - Country:US
Mailing Address - Phone:260-456-6073
Mailing Address - Fax:260-744-9251
Practice Address - Street 1:5800 FAIRFIELD AVE.
Practice Address - Street 2:SUITE 220
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-3417
Practice Address - Country:US
Practice Address - Phone:260-456-6073
Practice Address - Fax:260-744-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental