Provider Demographics
NPI:1497869614
Name:BOLON, REBECCA P (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:P
Last Name:BOLON
Suffix:
Gender:F
Credentials:DDS MSD
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Mailing Address - Street 1:9311 N. MERIDIAN ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-846-6107
Mailing Address - Fax:317-846-6128
Practice Address - Street 1:9311 N. MERIDIAN ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-846-6107
Practice Address - Fax:317-846-6128
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN120090691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics