Individual
DR. GRANT DANIEL BOLLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1015 W IRONWOOD DR, COEUR D ALENE, ID 83814-2602
(208) 664-2160
Mailing address
1940 W RIVERSTONE DR APT 207, COEUR D ALENE, ID 83814-4995
(630) 390-8930
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5544
ID
Other
Enumeration date
07/10/2023
Last updated
07/10/2023
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