Individual
CODY RAY BOLLENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
24418 75TH ST, SALEM, WI 53168-9703
(262) 843-2004
Mailing address
24418 75TH ST, SALEM, WI 53168-9703
(262) 843-2004
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6001602-15
WI
Other
Enumeration date
07/05/2024
Last updated
07/05/2024
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