GARY BOUDREAU


Address: 12 Stillwater Ave, Bangor, ME 04401-3984
Phone: 2079416550

GARY BOUDREAU (NPI# 1467996330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1467996330
Entity Type Individual
Full Name GARY BOUDREAU
Credential LD
Practice Address 12 Stillwater Ave
Bangor
ME 04401-3984
Mailing Address 174 Bangor Rd
Benton
ME 04901-3532
Practice Telephone 2079416550
Practice Fax Number 2079733952
Enumeration Date 2016-12-13
Last Update Date 2016-12-13
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 122400000X Denturist 5535 ME Dental Providers

Office Location

Street Address 12 STILLWATER AVE
City BANGOR
State ME
Zip Code 04401-3984

Providers in the same location

NPI Name Taxonomy Address Enumeration
1538129804 Sandra Jean Wardwell Nurse Practitioner 12 Stillwater Ave, Bangor, ME 04401-3984 2006-03-23
1245858638 Saker Ghanayem Physical Therapist 12 Stillwater Ave, Bangor, ME 04401-3984 2020-07-11
1154973865 Kristina Buck Physical Therapist 12 Stillwater Ave, Bangor, ME 04401-3984 2019-07-12
1972047470 Elizabeth Laura Stevens Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2016-12-19
1740731470 David C Haluska Dmd Pllc Dentist 12 Stillwater Ave, Suite 6, Bangor, ME 04401-3984 2016-10-18
1912365727 Raylene D Jernigan Advanced Practice Midwife 12 Stillwater Ave, Suite 1, Bangor, ME 04401-3984 2016-02-08
1205231651 Paul N Smith Md, Pa Specialist 12 Stillwater Ave, Suite 1, Bangor, ME 04401-3984 2014-10-28
1932515095 Heather Mitchell Specialist/Technologist 12 Stillwater Ave, Bangor, ME 04401-3984 2014-07-09
1679902076 Erika Jeanne Beckwith Physical Therapist 12 Stillwater Ave, Bangor, ME 04401-3984 2013-11-06
1023367125 David Christopher Haluska Dentist 12 Stillwater Ave, Ste 6, Bangor, ME 04401-3984 2012-09-05
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1184222523 Bj's Wholesale Club Inc. Eyewear Supplier (Equipment, not the service) 110 Longview Dr, Bangor, ME 04401 2020-10-16
1033737937 Daniel John Phulman Counselor 202 Exchange Street, Bangor, ME 04401 2020-07-08
1770104358 Elizabeth Sarah Caruson Physician Assistant 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 2020-05-05
1053961300 Erika Dean Occupational Therapist 84 Sylvan Rd., Bangor, ME 04401 2019-09-18
1942853635 Wildworks Therapy, Pllc Occupational Therapist 123 Mt Hope Ave, Bangor, ME 04401 2019-07-22
1255999173 Jessica Arbisi Physician Assistant 1 Northeast Drive, Bangor, ME 04401 2019-06-05
1699232041 Ehab Khamis Elhefnawi Anesthesiology Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 2019-02-21
1477028884 Zvorufura Makura Otolaryngology 885 Union Street, Ste 145, Bangor, ME 04401 2018-10-11
1255826541 Lindsey M Fields Optometrist 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 2018-06-28
1992211338 Debra J Mcintyre Counselor 157 Park Street, #5, Bangor, ME 04401 2017-12-21
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Taxonomy Information

Taxonomy Code 122400000X
Grouping Dental Providers
Classification Denturist

Taxonomy Definition

Definition to come.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1396974390 Classic Dentures of Maine Denturist 61 Hersey Ave, Bangor, ME 04401-4443 2009-07-11
1053546663 Rebecca J Connor Denturist 348 Buck St, Bangor, ME 04401-5932 2009-05-27
1972047470 Elizabeth Laura Stevens Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2016-12-19
1700015526 Joseph S Kingston Denturist 61 Hersey Ave, Bangor, ME 04401-4443 2009-07-14
1396970802 Stephanie R Buxton Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2009-05-28
1366677965 Austin J Carbone Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2009-05-27
1528293123 Megan E Higgins Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2009-05-27
1003041609 Sherry M Bodge Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2009-05-27
1629203385 Patrick D Allen Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2009-05-26
1750501318 New England Denture Center Denturist 12 Stillwater Ave, Bangor, ME 04401-3984 2007-04-26
Find all providers in BANGOR

Competitor

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City BANGOR
Zip Code 04401

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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