Provider Demographics
NPI:1881829752
Name:BOUGAS, PETER N JR
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:N
Last Name:BOUGAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 MAIN ST E STE A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3358
Mailing Address - Country:US
Mailing Address - Phone:770-979-5300
Mailing Address - Fax:770-978-5928
Practice Address - Street 1:2381 MAIN ST E STE A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3358
Practice Address - Country:US
Practice Address - Phone:770-979-5300
Practice Address - Fax:770-978-5928
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics