Individual
LAUREN BOLLENBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(215) 898-8965
Mailing address
1425 KATER ST, PHILADELPHIA, PA 19146-1682
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
12013473A
IN
1223P0221X
Pediatric Dentistry
8925
KY
1223P0221X
Pediatric Dentistry
9380
NC
1223P0221X
Pediatric Dentistry
Primary
DS044380
PA
Other
Enumeration date
04/24/2010
Last updated
01/30/2024
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