Provider Demographics
NPI:1720226673
Name:BOLANOS, OSCAR R (DDS)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:R
Last Name:BOLANOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S. UNIVERSITY DR.
Mailing Address - Street 2:ASSEMBLY BLDG #2 ROOM 202
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-262-7500
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:3200 S. UNIVERSITY DR.
Practice Address - Street 2:COLLEGE OF DENTAL MEDICINE
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-262-7500
Practice Address - Fax:954-262-2269
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP5011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics