NPIMap

Organization Active NPI

Debora a. Bolton, DDS, PA

Doing business as Willowdaile Family Dentistry

  • General Practice Dentistry
  • Durham, NC
National Provider Identifier
1104007996
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7251 Issued in NC
Legal business name
DEBORA A. BOLTON, DDS, PA
Doing business as
Willowdaile Family Dentistry
Practice address
3823 Guess Rd
Suite P
Durham, NC 27705-1505
Phone
(919) 479-5800
Fax
(919) 620-9244
NPI assigned
Nov 20, 2007
Last updated
Nov 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
Dr. Debora A Bolton, DDSNPI 1316975428
Title
Dentist
Phone
(919) 479-5800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7251 NC Primary

Addresses

Primary practice location

3823 Guess Rd
Suite P
Durham, NC 27705-1505

Mailing address

3823 Guess Rd
Suite P
Durham, NC 27705-1505
Phone (919) 479-5800

Other identifiers 1

IdentifierTypeStateIssuer
5900493MedicaidNC

Other names 1

  • Willowdaile Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

3823 Guess Rd
Ste P
Durham, NC 27705
Phone (919) 479-5800

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1104007996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3823 GUESS RD",
            "address_2": "SUITE P",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277051505",
            "telephone_number": "919-479-5800",
            "fax_number": "919-620-9244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3823 GUESS RD",
            "address_2": "SUITE P",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277051505",
            "telephone_number": "919-479-5800",
            "fax_number": "919-620-9244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEBORA A. BOLTON, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "DEBORA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "919-479-5800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900493",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willowdaile Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; 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.