Basic Information
| Provider Information | |||||||||
| NPI: | 1316975428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLTON | ||||||||
| FirstName: | DEBORA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3823 GUESS RD | ||||||||
| Address2: | SUITE P | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194795800 | ||||||||
| FaxNumber: | 9196209244 | ||||||||
| Practice Location | |||||||||
| Address1: | 3823 GUESS RD | ||||||||
| Address2: | SUITE P | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277051533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194795800 | ||||||||
| FaxNumber: | 9196209244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 7251 | NC | Y | Dental Providers | Dentist | General Practice |
No ID Information.