Provider Demographics
NPI:1558085563
Name:BOUYEAN DENTISTRY PLLC
Entity Type:Organization
Organization Name:BOUYEAN DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-505-1257
Mailing Address - Street 1:1108 W DICKINSON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-4201
Mailing Address - Country:US
Mailing Address - Phone:432-336-8700
Mailing Address - Fax:
Practice Address - Street 1:1108 W DICKINSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-4201
Practice Address - Country:US
Practice Address - Phone:432-336-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty