Individual
JIMMY CARROLL BOLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
1106 HIGH VISTA LN, RICHARDSON, TX 75080-1520
(972) 808-0221
Mailing address
1106 HIGH VISTA LN, RICHARDSON, TX 75080-1520
(972) 808-0221
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7425
TX
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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