Provider Demographics
NPI:1588143762
Name:WM BOLAK DMD PLLC
Entity type:Organization
Organization Name:WM BOLAK DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-964-3636
Mailing Address - Street 1:5501 INDEPENDENCE PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5470
Mailing Address - Country:US
Mailing Address - Phone:972-964-3636
Mailing Address - Fax:972-499-2420
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5470
Practice Address - Country:US
Practice Address - Phone:972-964-3636
Practice Address - Fax:972-499-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty