Provider Demographics
NPI:1275788481
Name:BOLDT, JOSEPH RAYMOND II (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:BOLDT
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4855
Mailing Address - Country:US
Mailing Address - Phone:203-869-1774
Mailing Address - Fax:
Practice Address - Street 1:69 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4855
Practice Address - Country:US
Practice Address - Phone:203-869-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist