Individual provider Active NPI

Raymond L Bolt, DMD

  • General Practice Dentistry
  • Auburn, AL
National Provider Identifier
1497833552
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3315 Issued in AL
Practice address
1550 Opelika Road
Auburn, AL 36830
Phone
(334) 466-9970
Fax
(334) 466-8915
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3315 AL Primary

Addresses

Primary practice location

1550 Opelika Road
Auburn, AL 36830

Mailing address

1550 Opelika Road
Suite 6-167
Auburn, AL 36830
Phone (334) 466-9970

Other identifiers 1

IdentifierTypeStateIssuer
009973950MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20260209000650 AL Order and Referring Only - DentistPractitioner - Dentist 0547749715

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3315ALMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Raymond L. Bolt, DMD PC PastSince Jul 24, 2022 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497833552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 OPELIKA ROAD",
            "address_2": "SUITE 6-167",
            "city": "AUBURN",
            "state": "AL",
            "postal_code": "36830",
            "telephone_number": "334-466-9970",
            "fax_number": "334-466-8915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 OPELIKA ROAD",
            "city": "AUBURN",
            "state": "AL",
            "postal_code": "36830",
            "telephone_number": "334-466-9970",
            "fax_number": "334-466-8915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLT",
        "first_name": "RAYMOND",
        "middle_name": "L",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "3315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009973950",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Auburn, AL

Sources for this page

Verify at the official NPI Registry.