Provider Demographics
NPI:1265647077
Name:BOUCHARD, NORMAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:J
Last Name:BOUCHARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 1ST ST SE
Mailing Address - Street 2:2ND FLOOR, REAR BLDG
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1804
Mailing Address - Country:US
Mailing Address - Phone:202-863-1600
Mailing Address - Fax:
Practice Address - Street 1:412 1ST ST SE
Practice Address - Street 2:2ND FLOOR, REAR BLDG
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1804
Practice Address - Country:US
Practice Address - Phone:202-863-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC003463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist