Individual
DR. BLAKE DENTON BOLEWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
525 THOMASTOWN LN STE A, RIDGELAND, MS 39157-3440
(601) 856-3054
Mailing address
525 THOMASTOWN LN STE A, RIDGELAND, MS 39157-3440
(601) 856-3054
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
OR-575-20
MS
Other
Enumeration date
09/17/2020
Last updated
08/14/2023
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