Provider Demographics
NPI:1588648299
Name:BOLTON, DAN W III (BA,,DC, DO,JD, LLM)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:W
Last Name:BOLTON
Suffix:III
Gender:M
Credentials:BA,,DC, DO,JD, LLM
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Mailing Address - Street 1:10580 N MCCARRAN BLVD
Mailing Address - Street 2:SUITE 115-395
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1895
Mailing Address - Country:US
Mailing Address - Phone:530-479-0241
Mailing Address - Fax:530-479-0241
Practice Address - Street 1:10580 N MCCARRAN BLVD
Practice Address - Street 2:SUITE 115-395
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-1895
Practice Address - Country:US
Practice Address - Phone:530-479-0241
Practice Address - Fax:530-479-0241
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2013-03-13
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Provider Licenses
StateLicense IDTaxonomies
NV358207Q00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine