Provider Demographics
NPI:1568559532
Name:BOLLMEIER, ELLEN CLEARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CLEARY
Last Name:BOLLMEIER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 TANGLEWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3112
Mailing Address - Country:US
Mailing Address - Phone:618-624-6001
Mailing Address - Fax:618-624-6001
Practice Address - Street 1:2010 WEST HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-622-8888
Practice Address - Fax:618-622-9888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0186131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice