Ian Michael Bolin, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12913 Issued in CT

Practice address

44 Old Ridgefield Rd
Wilton, CT 06897-3055

Phone

(203) 762-2322

NPI assigned

Jul 29, 2021

Sex

Male

Sole proprietor

Yes

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, last updated by the provider on Mar 3, 2022.

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1407529043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 HILLSIDE AVE",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064607808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 OLD RIDGEFIELD RD",
            "city": "WILTON",
            "state": "CT",
            "postal_code": "068973055",
            "telephone_number": "203-762-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "IAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-29",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "062078",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "12913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Blose
• Blue ABA Connecticut LLC
• Richard S Boas
• Lauren Boggs, PHYSICIAN ASSISTANT
• Alexandra Marie Bolan, LCSW
• Courtney Van Houten Boucher, MA, LMFT
• Ethan Emery Bourque
• Robert Lee Brady, M.D.
• Christopher M Braley, PSYD
• Barbara Suzanne Brandvold, PT

• All providers in Wilton, CT
• Orthodontics and Dentofacial Orthopedics Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.