Individual
DANITA ANTIONETTE BOLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
6801 MCCART AVE STE B2, FORT WORTH, TX 76133-6368
(817) 423-9300
(817) 423-9097
Mailing address
204 MILLFORD RD, ROANOKE, TX 76262-5085
(817) 490-1817
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20698
TX
Other
Enumeration date
02/27/2007
Last updated
09/19/2007
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