Provider Demographics
NPI:1821259227
Name:BOLEK, MARGARET (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:BOLEK
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 1:2603 W RAWSON AVE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8422
Mailing Address - Country:US
Mailing Address - Phone:414-761-9902
Mailing Address - Fax:414-761-9904
Practice Address - Street 1:2603 W RAWSON AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8422
Practice Address - Country:US
Practice Address - Phone:414-761-9902
Practice Address - Fax:414-761-9904
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist