Provider Demographics
NPI:1487670253
Name:BOLLA, DEBRA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:BOLLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8907 WARNER AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5075
Mailing Address - Country:US
Mailing Address - Phone:714-848-7777
Mailing Address - Fax:714-848-7388
Practice Address - Street 1:8907 WARNER AVE
Practice Address - Street 2:STE 100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5075
Practice Address - Country:US
Practice Address - Phone:714-848-7777
Practice Address - Fax:714-848-7388
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist