Provider Demographics
NPI:1760501944
Name:J.C. BOLEY, D.D.S., M.S., INC.
Entity Type:Organization
Organization Name:J.C. BOLEY, D.D.S., M.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:BOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-231-4896
Mailing Address - Street 1:400 S COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5708
Mailing Address - Country:US
Mailing Address - Phone:972-231-4896
Mailing Address - Fax:972-994-9747
Practice Address - Street 1:400 S COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5708
Practice Address - Country:US
Practice Address - Phone:972-231-4896
Practice Address - Fax:972-994-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C652OtherBCBSINSURANCE PROVIDER #