GARY BOUDREAU (NPI# 1467996330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 122400000X | Denturist | 5535 | ME | Dental Providers |
Street Address |
12 STILLWATER AVE |
City | BANGOR |
State | ME |
Zip Code | 04401-3984 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 04401 |
Taxonomy Code | 122400000X |
Grouping | Dental Providers |
Classification | Denturist |
Definition to come. |
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 |
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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.