Provider Demographics
NPI:1710038955
Name:BOLTON, CYNTHIA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5340
Mailing Address - Country:US
Mailing Address - Phone:336-349-9248
Mailing Address - Fax:336-349-6440
Practice Address - Street 1:1123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5340
Practice Address - Country:US
Practice Address - Phone:336-349-9248
Practice Address - Fax:336-349-6440
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90856OtherBLUE CROSS BLUE SHIELD #
NC8990856Medicaid
NC90856OtherBLUE CROSS BLUE SHIELD #