Provider Demographics
NPI:1578235792
Name:KEVIN BOLGER DDS PLLC
Entity Type:Organization
Organization Name:KEVIN BOLGER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOLGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-880-1252
Mailing Address - Street 1:5 GOVERNORS CIR
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-9606
Mailing Address - Country:US
Mailing Address - Phone:585-880-1252
Mailing Address - Fax:
Practice Address - Street 1:6536 ANTHONY DR STE A
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1419
Practice Address - Country:US
Practice Address - Phone:585-924-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty