Provider Demographics
NPI:1114490950
Name:MARK BOURCIER DMD PLLC
Entity Type:Organization
Organization Name:MARK BOURCIER DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURCIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-657-7237
Mailing Address - Street 1:134 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1172
Mailing Address - Country:US
Mailing Address - Phone:413-657-7237
Mailing Address - Fax:
Practice Address - Street 1:33 SOUTHWICK ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2023
Practice Address - Country:US
Practice Address - Phone:413-786-7555
Practice Address - Fax:413-786-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty