Grant Daniel Bolle, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-5544 Issued in ID

Practice address

1015 W Ironwood Dr
Coeur D Alene, ID 83814-2602

Phone

(208) 664-2160

NPI assigned

Jul 10, 2023

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1740968676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 W RIVERSTONE DR APT 207",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144995",
            "telephone_number": "630-390-8930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142602",
            "telephone_number": "208-664-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLE",
        "first_name": "GRANT",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-5544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bodhicitta Counseling Iop
• Bodhicitta Counseling LLC
• Janine Boer
• Tarah L. Boerner, RD
• Christopher Aldon Boggess, DC
• Matina Bolster, LPC
• Melanie Carin Bond, MOT, OTR/L
• Bone Density of North Idaho LLC
• Ryan Bones, DC
• Courtney Bonin

• General Practice Dentistry in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.