Provider Demographics
NPI:1265656599
Name:BOSSIER, GERARD JUDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JUDE
Last Name:BOSSIER
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 1:14127 GREENWELL SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:70739
Mailing Address - Country:US
Mailing Address - Phone:225-261-0043
Mailing Address - Fax:225-261-0046
Practice Address - Street 1:14127 GREENWELL SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:70739
Practice Address - Country:US
Practice Address - Phone:225-261-0043
Practice Address - Fax:225-261-0046
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist