NPI 1467996330

Gary Boudreau, LD

Practitioner Denturist Bangor, ME

Practice location

Address: 12 Stillwater Ave, Bangor, ME 04401-3984
Phone: (207) 941-6550
Fax: (207) 973-3952
Mailing address: 174 Bangor Rd, Benton, ME 04901-3532

Registered specialties

Denturist Primary

Dental Providers Taxonomy 122400000X Licence 5535 (ME)

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Registry record

NPI: 1467996330
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Dec 2016
Record last updated: 13 Dec 2016

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.