Provider Demographics
NPI:1740368893
Name:BOLDEN, CAROL BAYLESS (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:BAYLESS
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:B
Other - Last Name:BAYLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2525 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6807
Mailing Address - Country:US
Mailing Address - Phone:770-924-8138
Mailing Address - Fax:770-924-8139
Practice Address - Street 1:2525 SHALLOWFORD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6807
Practice Address - Country:US
Practice Address - Phone:770-924-8138
Practice Address - Fax:770-924-8139
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice