Provider Demographics
NPI:1720105679
Name:BOLT, NANCY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:N
Last Name:BOLT
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:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-0196
Mailing Address - Country:US
Mailing Address - Phone:317-852-7112
Mailing Address - Fax:
Practice Address - Street 1:307 N GREEN ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1022
Practice Address - Country:US
Practice Address - Phone:317-852-7112
Practice Address - Fax:810-815-1715
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008249A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice