Provider Demographics
NPI:1962239772
Name:BOLIVAR, JULIO MIGUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:MIGUEL
Last Name:BOLIVAR
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 1:24671 ALAMITOS DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2701
Mailing Address - Country:US
Mailing Address - Phone:703-371-3892
Mailing Address - Fax:
Practice Address - Street 1:24671 ALAMITOS DR
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2701
Practice Address - Country:US
Practice Address - Phone:703-371-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1107561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice