Provider Demographics
NPI:1770597197
Name:BOLLEN, ANNE-MARIE (DDS, MS, PHD)
Entity type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:BOLLEN
Suffix:
Gender:F
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 164TH ST SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6316
Mailing Address - Country:US
Mailing Address - Phone:425-741-8209
Mailing Address - Fax:
Practice Address - Street 1:805 164TH ST SE
Practice Address - Street 2:SUITE 205
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6316
Practice Address - Country:US
Practice Address - Phone:425-741-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000065131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5035092Medicaid