Individual
MARK D BOLLAERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3001 41ST ST, MOLINE, IL 61265-7826
(309) 764-1173
Mailing address
3001 41ST ST, MOLINE, IL 61265-7826
(309) 764-1173
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19A15530
IL
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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