Marisol Bolivar, DMD, MS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN22944 Issued in FL

Practice address

250 Paseo Reyes Dr
St Augustine, FL 32095-8462

Phone

(904) 429-3387

Fax

(904) 429-3888

NPI assigned

Aug 8, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Marisol Carbonell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1386991446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 PASEO REYES DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958462",
            "telephone_number": "904-429-3387",
            "fax_number": "904-429-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PASEO REYES DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958462",
            "telephone_number": "904-429-3387",
            "fax_number": "904-429-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIVAR",
        "first_name": "MARISOL",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN22944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISOL",
            "last_name": "CARBONELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Oleg Bohomol, PT
• Adrianna Zenia Bokalo, MED
• Josephine Luz Bokowski, LMHC, NCC, CBA
• Bold City Dermatology LLC
• Clarrissa Bolin
• Lori Ann Bolt, BCBA
• Samantha Bolton, RD
• Javier Bonamego
• Isabel Karine Boneta
• Olivia Bonjour

• Pediatric Dentistry in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.