NPI 1255561320

Kenneth Wayne Bourgeois, DDS

Practitioner General Practice Dentistry Tamuning, GU

Practice location

Address: 226 Chalan San Antonio STE C, Tamuning, GU 96913-3525
Phone: (671) 646-2010
Fax: (671) 646-2070

Registered specialties (2)

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence D927 (GU)

Other Dentist providers in Guam →

General Practice Dentistry

Dental Providers Taxonomy 1223G0001X Licence 14605 (TX)

Registry record

NPI: 1255561320
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Jul 2009
Record last updated: 22 Jul 2009

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.