Provider Demographics
NPI:1831211218
Name:BOUHANA, THOMAS LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LOUIS
Last Name:BOUHANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11479 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2737
Mailing Address - Country:US
Mailing Address - Phone:810-632-5364
Mailing Address - Fax:810-632-9576
Practice Address - Street 1:11479 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2737
Practice Address - Country:US
Practice Address - Phone:810-632-5364
Practice Address - Fax:810-632-9576
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0121791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice