Provider Demographics
NPI:1467588574
Name:BOLCHOZ, RUFORD JOSEPH JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUFORD
Middle Name:JOSEPH
Last Name:BOLCHOZ
Suffix:JR
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 1:1059 CHUCK DAWLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4181
Mailing Address - Country:US
Mailing Address - Phone:843-884-6002
Mailing Address - Fax:
Practice Address - Street 1:1059 CHUCK DAWLEY BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4181
Practice Address - Country:US
Practice Address - Phone:843-884-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice