Provider Demographics
NPI:1679913578
Name:BECHARA, BOULOS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BOULOS
Middle Name:
Last Name:BECHARA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 CHAMBERS RD
Mailing Address - Street 2:APT. #525
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2671
Mailing Address - Country:US
Mailing Address - Phone:210-218-9683
Mailing Address - Fax:
Practice Address - Street 1:35508 S VALLEY VISTA PR SE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-9431
Practice Address - Country:US
Practice Address - Phone:509-566-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288661223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology