Provider Demographics
NPI:1659672038
Name:WILLIAM C. BOLICK D.DS L.L.C.
Entity Type:Organization
Organization Name:WILLIAM C. BOLICK D.DS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-234-2684
Mailing Address - Street 1:424 SOUTH ST.
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1516
Mailing Address - Country:US
Mailing Address - Phone:319-234-2684
Mailing Address - Fax:319-233-5974
Practice Address - Street 1:424 SOUTH ST.
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-1516
Practice Address - Country:US
Practice Address - Phone:319-234-2684
Practice Address - Fax:319-233-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA65261223G0001X
IA087021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty