Provider Demographics
NPI:1316435472
Name:BOLAY, SHERI (OM)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:BOLAY
Suffix:
Gender:F
Credentials:OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 NW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2015
Mailing Address - Country:US
Mailing Address - Phone:405-840-3119
Mailing Address - Fax:
Practice Address - Street 1:3629 NW 68TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2015
Practice Address - Country:US
Practice Address - Phone:405-840-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist