# ANNELI K BOLLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1780661595
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS-030926-L | PA | Yes |

## Other

- **Enumeration date:** 12/22/2005
- **Last updated:** 03/07/2023

## 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 |