Provider Demographics
NPI:1407025109
Name:DARREN BOLES, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:DARREN BOLES, D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-366-4400
Mailing Address - Street 1:36 ENDICOTT ST E
Mailing Address - Street 2:PO BOX 5577
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-1992
Mailing Address - Country:US
Mailing Address - Phone:603-366-4400
Mailing Address - Fax:603-366-4410
Practice Address - Street 1:36 ENDICOTT ST E
Practice Address - Street 2:SUITE 15 & 16
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-1992
Practice Address - Country:US
Practice Address - Phone:603-366-4400
Practice Address - Fax:603-366-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1275620098Medicaid