Provider Demographics
NPI:1487002135
Name:BOLT HESS DDS, LLC
Entity Type:Organization
Organization Name:BOLT HESS DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-797-9111
Mailing Address - Street 1:307 N GREEN ST
Mailing Address - Street 2:BROWNSBURG
Mailing Address - City:IN
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1022
Mailing Address - Country:US
Mailing Address - Phone:317-852-7112
Mailing Address - Fax:
Practice Address - Street 1:307 N GREEN ST
Practice Address - Street 2:BROWNSBURG
Practice Address - City:IN
Practice Address - State:IN
Practice Address - Zip Code:46012-1022
Practice Address - Country:US
Practice Address - Phone:317-852-7112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012466A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty