Shaletha M Bolden, DDS, MSD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DN015429 Issued in GA

Practice address

1425 Riverstone Pkwy Ste 200
Canton, GA 30114-5611

Phone

(770) 479-0600

NPI assigned

Jul 15, 2008

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• FL HMO D-SNP
• TN PPO C-SNP
• FL HMO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Canton Smiles Dentistry, PC

  dba Canton Smiles Dentistry

  • Dentist
  • Canton, GA
  • NPI 1093149486
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1013171438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 RIVERSTONE PKWY",
            "address_2": "SUITE 200",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30114",
            "telephone_number": "770-479-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 RIVERSTONE PKWY STE 200",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145611",
            "telephone_number": "770-479-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDEN",
        "first_name": "SHALETHA",
        "middle_name": "M",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "27790",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TN",
            "license": "8802",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "DN015429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Ridge Hospice, Inc.
• Bluesprig Autism
• Sara Elizabeth Bobo, NP
• Amy B Boehm, RD, LD
• David Paul Boggs, PT
• Bolt Eye Group-Canton LLC
• Itka G Bones-Rivera, DC
• Bonnie Craemer LLC
• Garrett Boures
• Jed Wyatt Bowen

• Endodontics in Canton, GA
• Providers in Canton, GA by specialty
• Endodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.