Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5188 | OR |
N | 124Q00000X | Dental Hygienist | HL00007981 | WA |
NPI | 1043570575 |
---|---|
Provider Name | Ashley Bolds |
First Address | Vancouver, WA 98661-1866 |
Second Address | Portland, OR 97232-1127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 04/01/2022 |