Provider Demographics
NPI:1144604984
Name:BOLDRA, CHRISTINE (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BOLDRA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25997 CONIFER RD STE C
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9057
Mailing Address - Country:US
Mailing Address - Phone:303-838-7003
Mailing Address - Fax:
Practice Address - Street 1:25997 CONIFER RD STE C
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9057
Practice Address - Country:US
Practice Address - Phone:303-838-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000905358124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1235597725OtherGROUP NPI