Provider Demographics
NPI:1508948761
Name:BOLES, JAMES M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:BOLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 FLY CREEK AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-990-7797
Mailing Address - Fax:251-990-7769
Practice Address - Street 1:7540 CIPRIANO CT
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3029
Practice Address - Country:US
Practice Address - Phone:251-990-7797
Practice Address - Fax:251-990-7769
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51090563OtherBCBS PROVIDER NUMBER