Organization
BRANT BOLING, DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANT BOLING DDS (MANAGER)
(817) 598-0835
Entity
Organization
Contact information
Practice address
1429 CLEAR LAKE RD STE 700, WEATHERFORD, TX 76086-5805
(817) 598-0835
(817) 598-0845
Mailing address
1429 CLEAR LAKE RD STE 700, WEATHERFORD, TX 76086-5805
(817) 598-0835
(817) 598-0845
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
019240
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962664-04
—
TX
Enumeration date
08/03/2009
Last updated
01/20/2010
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