Provider Demographics
NPI:1821087214
Name:BOLLAERT, WILLIAM TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TODD
Last Name:BOLLAERT
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 1:16 WILDERNESS CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6148
Mailing Address - Country:US
Mailing Address - Phone:309-797-3836
Mailing Address - Fax:
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4716
Practice Address - Country:US
Practice Address - Phone:309-344-2595
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1917067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist