Individual
SHALETHA M BOLDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MSD
Contact information
Practice address
1425 RIVERSTONE PKWY STE 200, CANTON, GA 30114-5611
(770) 479-0600
Mailing address
1425 RIVERSTONE PKWY, SUITE 200, CANTON, GA 30114
(770) 479-0600
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
27790
TX
1223E0200X
Endodontics
8802
TN
1223E0200X
Endodontics
Primary
DN015429
GA
Other
Enumeration date
07/15/2008
Last updated
07/21/2022
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