Provider Demographics
NPI:1750001798
Name:BOUCHER, ANNA MARIE (RDH)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4622
Mailing Address - Country:US
Mailing Address - Phone:580-695-0597
Mailing Address - Fax:
Practice Address - Street 1:14228 BARBOUR AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-3410
Practice Address - Country:US
Practice Address - Phone:405-752-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4682124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist