Provider Demographics
NPI:1962686030
Name:BOUCREE, STANLEY ANTHONY JR (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ANTHONY
Last Name:BOUCREE
Suffix:JR
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8555 16TH STREET, STE. 404
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:202-265-5910
Mailing Address - Fax:301-585-5901
Practice Address - Street 1:8555 16TH ST STE 404
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:202-265-5910
Practice Address - Fax:301-585-5901
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5938122300000X
MD15670122300000X
DCMD036903207P00000X
MDD71459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No122300000XDental ProvidersDentist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine