Bolton Lake Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BOLTON LAKE DENTAL LLC

Practice address

1120 Boston Tpke
Bolton, CT 06043-7439

Phone

(860) 646-3003

NPI assigned

Feb 5, 2020

Last updated

Feb 5, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Cristina Ilies, DDS

Title

Owner

Phone

(860) 646-3003

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Sahar Mohebbi-Pour

  • Dentist
  • Bolton, CT
  • NPI 1417631441
  NPD

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1194357418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 BOSTON TPKE",
            "city": "BOLTON",
            "state": "CT",
            "postal_code": "060437439",
            "telephone_number": "860-646-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 BOSTON TPKE",
            "city": "BOLTON",
            "state": "CT",
            "postal_code": "060437439",
            "telephone_number": "860-646-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLTON LAKE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-05",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "ILIES",
        "authorized_official_first_name": "CRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-646-3003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Anzures, MA SLP-CCC
• Bolton Board of Education
• Bolton Pharmacy Inc
• Bolton Physical Therapy & Sports Performance LLC
• Megan A Bouffard, ABOC NCLEC
• Monique Marie Brunelle, DNP, APRN, FNP-BC
• Ronald L Buckman, M.D.

• Dental Clinic/Center in Bolton, CT
• Providers in Bolton, CT by specialty
• Dental Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.