Organization
BOLTON LAKE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRISTINA ILIES DDS (OWNER)
(860) 646-3003
Entity
Organization
Contact information
Practice address
1120 BOSTON TPKE, BOLTON, CT 06043-7439
(860) 646-3003
Mailing address
1120 BOSTON TPKE, BOLTON, CT 06043-7439
(860) 646-3003
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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