Provider Demographics
NPI:1770538837
Name:BOLEN, BRUCE P (DMD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
Last Name:BOLEN
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 1:2 HOOPER STREET
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3213
Mailing Address - Country:US
Mailing Address - Phone:781-631-3799
Mailing Address - Fax:781-631-2578
Practice Address - Street 1:2 HOOPER STREET
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3213
Practice Address - Country:US
Practice Address - Phone:781-631-3799
Practice Address - Fax:781-631-2578
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist