Organization
J.C. BOLEY, D.D.S., M.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY CARROLL BOLEY D.D.S., M.S. (PRESIDENT)
(972) 231-4896
Entity
Organization
Contact information
Practice address
400 S COTTONWOOD DR, RICHARDSON, TX 75080-5708
(972) 231-4896
(972) 994-9747
Mailing address
400 S COTTONWOOD DR, RICHARDSON, TX 75080-5708
(972) 231-4896
(972) 994-9747
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7425
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C652
BCBSINSURANCE PROVIDER #
TX
Enumeration date
03/28/2007
Last updated
08/22/2020
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