Lillia Bolboli

Primary specialty

DentistTaxonomy code 122300000X

License

DDS-10114 Issued in IA

Practice address

1751 E 54TH St
Davenport, IA 52807-2769

Phone

(563) 355-6626

NPI assigned

Jun 15, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Community Health Centers of Southeastern Iowa Inc

  • Federally Qualified Health Center (FQHC)
  • West Burlington, IA
  • NPI 1255339750
  Medicare reassignment
• Kathryn a. Kell DDS PC

  • Dental Clinic/Center
  • Davenport, IA
  • NPI 1336511120
  NPD (past)

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1114601432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 ARCH ROCK RD",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522452700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 E 54TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072769",
            "telephone_number": "563-355-6626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3475 Jersey Ridge Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "528072293",
            "country_code": "US",
            "telephone_number": "563-554-2573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLBOLI",
        "first_name": "LILLIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-10114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Bobst, BASW
• Maddilyn Boche, LMSW
• Lynn Marie Boelger, D.C.
• Ronnie J. Boesch, D.C.
• Margaret Jean Bohnert, OT
• Randall E Boldt, PT
• Bolger Aesthestics, PC
• James Randall Bolton, LISW
• Prakash R Bontu, M.D.
• Rupa Bontu, MD

• Dentist in Davenport, IA
• Providers in Davenport, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.