Provider Demographics
NPI:1922526813
Name:DARREN BOLES DDS PLLC
Entity Type:Organization
Organization Name:DARREN BOLES DDS PLLC
Other - Org Name:SAINT JOHNSBURY DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-748-9357
Mailing Address - Street 1:1 PLACE NOTRE DAME
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2223
Mailing Address - Country:US
Mailing Address - Phone:802-748-9357
Mailing Address - Fax:802-748-8770
Practice Address - Street 1:1 PLACE NOTRE DAME
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2223
Practice Address - Country:US
Practice Address - Phone:802-748-9357
Practice Address - Fax:802-748-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0131858261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental