Provider Demographics
NPI:1558403279
Name:BOLTEN, MICHAEL JAMES
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BOLTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 ELDORADO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6185
Mailing Address - Country:US
Mailing Address - Phone:972-547-0554
Mailing Address - Fax:972-547-4865
Practice Address - Street 1:6633 ELDORADO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6185
Practice Address - Country:US
Practice Address - Phone:972-547-0554
Practice Address - Fax:972-547-4865
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist