Provider Demographics
NPI:1437229093
Name:BOURGEOIS, FREDERICK M (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:BOURGEOIS
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 1:15 IRON HORSE DR APT G310
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-606-1181
Mailing Address - Fax:
Practice Address - Street 1:43 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076
Practice Address - Country:US
Practice Address - Phone:603-635-2151
Practice Address - Fax:603-635-9924
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17891122300000X
NH3390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist