Provider Demographics
NPI:1699038299
Name:BOLDING, JARED D (DDS)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:D
Last Name:BOLDING
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 1:14202 Y ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2862
Mailing Address - Country:US
Mailing Address - Phone:402-895-2085
Mailing Address - Fax:402-895-3144
Practice Address - Street 1:14202 Y ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2862
Practice Address - Country:US
Practice Address - Phone:402-895-2085
Practice Address - Fax:402-895-3144
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice