Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DL12955 | MA |
NPI | 1619383437 |
---|---|
Provider Name | Carlos A Bolano |
First Address | Holyoke, MA 01040-5144 |
Second Address | Holyoke, MA 01040-5144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 01/06/2017 |