Cooper Francis Bolak, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60350473 Issued in WA

Practice address

4722 Fauntleroy Way SW Ste a
Seattle, WA 98116-4667

Phone

(206) 928-6242

NPI assigned

Aug 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Washington Dental Corporation, PC

  dba Dentists of West Seattle

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1619635877
  NPD

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1174524995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4722 FAUNTLEROY WAY SW STE A",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981164667",
            "telephone_number": "206-928-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4722 FAUNTLEROY WAY SW STE A",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981164667",
            "telephone_number": "206-928-6242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAK",
        "first_name": "COOPER",
        "middle_name": "FRANCIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8407",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25944",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60350473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cooper.bolak@washden.com",
            "affiliation": "Y",
            "endpointDescription": "email address",
            "affiliationName": "Pacific Dental Services",
            "address_1": "4722 Fauntleroy Way SW Ste A",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981164667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jelena Bojic, DPT
• John A. Bokan, MD
• Megan Maureen Bokan, MG 60558174
• Mary Elizabeth Bol
• Nyabuony Bol
• Maurine CK Boland
• Nicole Bolano
• Esther Ann Bolante, MD
• China R Bolden Jarvis, PHD
• Adrian Bolden

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.