Provider Demographics
NPI:1760595839
Name:BOURNE & TALBOT LLC
Entity Type:Organization
Organization Name:BOURNE & TALBOT LLC
Other - Org Name:SMILE MAKERS DENTAL CARE OF OCTILLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-895-3111
Mailing Address - Street 1:3225 S. ALMA SCHOOL RD
Mailing Address - Street 2:#102
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-895-3111
Mailing Address - Fax:480-899-5170
Practice Address - Street 1:3225 S. ALMA SCHOOL RD
Practice Address - Street 2:#102
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-895-3111
Practice Address - Fax:480-899-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty