Provider Demographics
NPI:1225152614
Name:BOUMERHI, PIERRE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:
Last Name:BOUMERHI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:439 SPRING ST.
Practice Address - Street 2:
Practice Address - City:HOUTZDALE
Practice Address - State:PA
Practice Address - Zip Code:16651
Practice Address - Country:US
Practice Address - Phone:814-378-7479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029496L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA792738OtherUNITED CONCORDIA
PA0015366400003Medicare ID - Type Unspecified