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GREGORY BOLDEN II D.D.S.
NPI 1114336344
Dentist in Detroit, MI

Active since August 13, 2014PECOS Enrolled
4646 JOHN R ST, DETROIT, MI 48201(313) 576-1000 Get Directions Write a Review

NPPES record last updated: October 16, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Gregory Bolden Ii D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREGORY BOLDEN II D.D.S. (NPI 1114336344) is an individual dentist in Detroit, Michigan, licensed in Michigan (2901021454) and active in the NPI registry since August 2014. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114336344
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameGREGORY BOLDEN IICredential: D.D.S.
Location Address4646 JOHN R STDetroit, MI 48201-1916
Mailing Address4646 John R StDetroit, MI 48201-1916 · (313) 576-1000
Phone(313) 576-1000
Sole ProprietorNo
Enumeration DateAugust 13, 2014
Last NPPES UpdateOctober 16, 2015
✔ NPI 1114336344 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MI · 2901021454
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
4646 JOHN R ST, Detroit, MI 48201
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gregory Bolden Ii D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48201 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$72.38 typical visit price
range $18.32 – $143.49
Typical copayment $18.09 (range $4.58 – $35.87)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. YURIJ CHERSTYLO
Student in an Organized Health Care Education/Training Program
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1000
NAVITHA LONAPPAN
Registered Nurse (Medical-Surgical)
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1000
SHARI KABETH RN
Registered Nurse (Gastroenterology)
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1000
DEREK CURTIS THAMARUS
Registered Nurse
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1294
MOLLY GEORGE
Registered Nurse
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1316
EDWIN RAYMOND MILLER
Registered Nurse
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1000
MR. EDWIN INTIG LOON JR.
Licensed Practical Nurse
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1000
ASHLEY NICOLE DANIELS MDIV
Religious Nonmedical Practitioner
4646 JOHN R ST
DETROIT, MI 48201
Wayne County (313) 576-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gregory Bolden's NPI number?

The NPI number for Gregory Bolden is 1114336344. It was assigned to this individual provider in the NPPES registry on August 13, 2014.

Where is Gregory Bolden located?

Gregory Bolden practices at 4646 John R St, Detroit, MI 48201. The listed phone number is (313) 576-1000.

What is Gregory Bolden's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Gregory Bolden enrolled in Medicare?

Yes. Gregory Bolden is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Gregory Bolden was last updated on October 16, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.