Mark Anthony Boldt, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

4290-015 Issued in WI

Practice address

2323 S. 109TH Street
Suite 295
West Allis, WI 53227

Phone

(414) 545-5225

Fax

(414) 545-5251

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

Yes

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

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486684800000",
    "number": "1831291996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 S. 109TH STREET",
            "address_2": "SUITE 295",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "53227",
            "telephone_number": "414-545-5225",
            "fax_number": "414-545-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 S. 109TH STREET",
            "address_2": "SUITE 295",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "53227",
            "telephone_number": "414-545-5225",
            "fax_number": "414-545-5251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDT",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2017-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "WI",
            "license": "4290-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Linda Jean Bolton, OTR
• Mary C Bolton, PSYD
• Jordan J Bonnett, AU.D.
• Ashley Lauren Boonnam, FNP-BC
• Catherine M Bopp, PAC

• Prosthodontics in West Allis, WI
• Providers in West Allis, WI by specialty
• Prosthodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.