David R Bolla, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

012328 Issued in MI

Practice address

1125 Thomas Edison Dr
Port Huron, MI 48060-8500

Phone

(810) 982-9821

Fax

(810) 982-9645

NPI assigned

May 16, 2007

Sex

Male

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

Not listed in the public Medicare enrollment file

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.

• Cotter & Easton General Dentistry, PLLC

  • General Practice Dentistry
  • Port Huron, MI
  • NPI 1538724828
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366658171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 THOMAS EDISON DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608500",
            "telephone_number": "810-982-9821",
            "fax_number": "810-982-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 THOMAS EDISON DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608500",
            "telephone_number": "810-982-9821",
            "fax_number": "810-982-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLA",
        "first_name": "DAVID",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "012328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Blume
• Jennifer Bocek, M. A. CCC-SLP
• Melissa Boggs, MA, BCBA
• Michael Bohne, CRNA
• Bolla, Cotter & Assoc., P.C.
• Karlene Bolman, LMSW
• Sherry Lynn Bombardo, CRNA
• Bone & Joint Institute P C
• Bone & Joint Institute, P.C.
• Bone & Joint Physical Therapy LLC

• General Practice Dentistry in Port Huron, MI
• Providers in Port Huron, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.