Provider Demographics
NPI:1134339468
Name:BOLAM, FAITH AFTRETH (DDS)
Entity type:Individual
Prefix:DR
First Name:FAITH
Middle Name:AFTRETH
Last Name:BOLAM
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 1:7557 EL CAJON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8623
Mailing Address - Country:US
Mailing Address - Phone:619-337-2970
Mailing Address - Fax:619-460-5822
Practice Address - Street 1:7557 EL CAJON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8623
Practice Address - Country:US
Practice Address - Phone:619-337-2970
Practice Address - Fax:619-460-5822
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist