Provider Demographics
NPI:1225308398
Name:DR. JENNIFER N. BOLES, DDS, LLC
Entity Type:Organization
Organization Name:DR. JENNIFER N. BOLES, DDS, LLC
Other - Org Name:SOUTHERN SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-248-4986
Mailing Address - Street 1:902 JULIA ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-2618
Mailing Address - Country:US
Mailing Address - Phone:318-728-8773
Mailing Address - Fax:318-728-8787
Practice Address - Street 1:902 JULIA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2618
Practice Address - Country:US
Practice Address - Phone:318-728-8773
Practice Address - Fax:318-728-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty