Provider Demographics
NPI:1285609693
Name:BOLICK, WILLIAM C (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:BOLICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1516
Mailing Address - Country:US
Mailing Address - Phone:319-234-2684
Mailing Address - Fax:319-233-5974
Practice Address - Street 1:424 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-1516
Practice Address - Country:US
Practice Address - Phone:319-234-2684
Practice Address - Fax:319-233-5974
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2500009Medicaid
IA171645OtherDELTA DENTAL
IA17164OtherBCBS