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Individual
ANNELI K BOLLER
Active
Individual
ANNELI K BOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS-030926-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001778089 003
—
PA
05
—
01892295
—
NY
01
—
047677-1
LICENSE
NY
01
—
DS-030926-L
LICENSE
PA
Enumeration date
12/22/2005
Last updated
03/07/2023
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