Provider Demographics
NPI:1477841476
Name:BOLLES, JORDAN ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ALAN
Last Name:BOLLES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S 40TH AVE STE F
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3800
Mailing Address - Country:US
Mailing Address - Phone:509-965-7668
Mailing Address - Fax:509-965-7520
Practice Address - Street 1:1020 S 40TH AVE STE F
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3800
Practice Address - Country:US
Practice Address - Phone:509-965-7668
Practice Address - Fax:509-965-7520
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program