# BOLINGER DENTAL L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114418654
- **Authorized official:** DR. CRAIG BOLINGER DDS (PRESIDENT/OWNER)
- **Authorized official phone:** (260) 456-6073

## Contact information

- **Practice address:** 5800 FAIRFIELD AVE., SUITE 220, FORT WAYNE, IN 46807-3417
- **Practice address phone:** (260) 456-6073
- **Practice address fax:** (260) 744-9251
- **Mailing address:** 5800 FAIRFIELD AVE., SUITE 220, FORT WAYNE, IN 46807-3417
- **Mailing address phone:** (260) 456-6073
- **Mailing address fax:** (260) 744-9251

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/21/2018
- **Last updated:** 05/21/2018