Provider Demographics
NPI:1982899126
Name:BOLDEN, TASHA W (DMDMSD)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:W
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:DMDMSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NAZARETH PIKE
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9002
Mailing Address - Country:US
Mailing Address - Phone:570-994-2048
Mailing Address - Fax:
Practice Address - Street 1:611 NAZARETH PIKE
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9002
Practice Address - Country:US
Practice Address - Phone:484-293-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366421223X0400X
NJ22D1023438001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics