Provider Demographics
NPI:1265515472
Name:BOLT, STEPHEN ERSKINE
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ERSKINE
Last Name:BOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570
Mailing Address - Country:US
Mailing Address - Phone:205-921-7806
Mailing Address - Fax:205-921-7806
Practice Address - Street 1:1760 MILITARY HIGHWAY SO
Practice Address - Street 2:DR DALE E BOLT
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570
Practice Address - Country:US
Practice Address - Phone:205-921-7806
Practice Address - Fax:205-921-7806
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice