Kenneth Anthony Bolin, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12794 Issued in TX

Practice address

14335 Regency PL
Dallas, TX 75254-8509

Phone

(972) 716-9787

Fax

(972) 716-9787

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1255334140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14335 REGENCY PL",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752548509",
            "telephone_number": "972-716-9787",
            "fax_number": "972-716-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14335 REGENCY PL",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752548509",
            "telephone_number": "972-716-9787",
            "fax_number": "972-716-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "KENNETH",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "12794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1267114-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruby Gladys Bolden, M.D.
• Larry Bolding Jr., MS, LPC
• Octavia Bolds
• Margot Boles, M.ED., BCBA
• Michael Joseph Bolesta, MD
• Janice A Bolinger, RPH
• Diana Bolivar, LBSW
• Srinivas Bollineni, M.D
• Lisa Bolling, R.PH.
• Adriana Bollinger

• Dentist in Dallas, TX
• Providers in Dallas, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; 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.