Provider Demographics
NPI:1184881922
Name:BOLGER, WALTON LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTON
Middle Name:LOUIS
Last Name:BOLGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12695 MCMANUS BLVD
Mailing Address - Street 2:BLDG 4 SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602
Mailing Address - Country:US
Mailing Address - Phone:757-877-1999
Mailing Address - Fax:757-877-7800
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:BLDG 4 SUITE A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-877-1999
Practice Address - Fax:757-877-7800
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist