Individual
MARISOL BOLIVAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
250 PASEO REYES DR, ST AUGUSTINE, FL 32095-8462
(904) 429-3387
(904) 429-3888
Mailing address
250 PASEO REYES DR, ST AUGUSTINE, FL 32095-8462
(904) 429-3387
(904) 429-3888
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN22944
FL
Other
Enumeration date
08/08/2012
Last updated
08/25/2022
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