Alberto Edinson Bolanos, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18041 Issued in FL

Practice address

4060 Pine Ridge Rd
Naples, FL 34119-4011

Phone

(239) 304-1974

Fax

(239) 304-1974

NPI assigned

Nov 21, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1396926150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 PINE RIDGE RD",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341194011",
            "telephone_number": "239-304-1974",
            "fax_number": "239-304-1971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 PINE RIDGE RD",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341194011",
            "telephone_number": "239-304-1974",
            "fax_number": "239-304-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "ALBERTO",
        "middle_name": "EDINSON",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-21",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "053453-1",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "18041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02908818",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanna P Boka, MD
• Bokey Home Care Services
• Yvonne Bokrand-Donatelli
• Danielle Boland
• Diana Lynn Boland, OT
• Thomas Bolanos
• Larrya Bolden
• Brian Bolin, PT
• Stefan M. Bolin, CRNA
• Katherine Boll, MSW

• General Practice Dentistry in Naples, FL
• Providers in Naples, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.