Daniel L Bolt, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901017602 Issued in MI

Practice address

845 E. 16TH St
Holland, MI 49423

Phone

(616) 392-2381

Fax

(616) 392-3748

NPI assigned

Nov 14, 2006

Last updated

Sep 28, 2021By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West Michigan Pediatric Dentistry

  • Pediatric Dentistry
  • Holland, MI
  • NPI 1942327259
  NPD

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1811069198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 E 16TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "49423",
            "telephone_number": "616-392-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 E. 16TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "49423",
            "telephone_number": "616-392-2381",
            "fax_number": "616-392-3748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLT",
        "first_name": "DANIEL",
        "middle_name": "L",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901017602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124383607",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Jo Boeve, LLP
• Theresa Ann Boeve, OTR/L
• Therese L. Boggiano, RN
• Noelle Abigail Bohannon, PA-C
• Sarah Mae Bolman
• Mark A Bombara
• William Barry Bonzelaar, M.D.54
• Judy Kaye Boogaart, LMSW
• Anthony Bordenkircher, LLMFT
• Amy Boren, DO

• Pediatric Dentistry in Holland, MI
• Providers in Holland, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; 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.