NPI 1023590452

Dominique Bouldin

Practitioner Driver White Plains, MD

Practice location

Address: 11136 Saint Christopher Drive, White Plains, MD 20695
Phone: (240) 718-8595
Mailing address: 11501 Highland Farm CT, La Plata, MD 20646-3301

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1023590452
Entity type: Individual
Sex (as registered): Female
NPI issued: 1 Sep 2018
Record last updated: 17 Jun 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.