Provider Demographics
NPI:1275652422
Name:BOUCHOUCHA, SLIM (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:SLIM
Middle Name:
Last Name:BOUCHOUCHA
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 SYLVA LN
Mailing Address - Street 2:SUITE K1
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-5578
Mailing Address - Fax:209-532-6216
Practice Address - Street 1:940 SYLVA LN
Practice Address - Street 2:SUITE K1
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-5578
Practice Address - Fax:209-532-6216
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA417051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery