Organization
MICHAEL G BOLUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELIZABETH MCBRIDE (OFFICE ADMINISTRATOR)
(919) 847-0150
Entity
Organization
Contact information
Practice address
700 EXPOSITION PL STE 191, RALEIGH, NC 27615-1563
(919) 847-0150
(919) 847-7384
Mailing address
700 EXPOSITION PL STE 191, RALEIGH, NC 27615-1563
(919) 847-0150
(919) 847-7384
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8785
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780819581
DENTISTRY
NC
Enumeration date
09/15/2014
Last updated
09/15/2014
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