Provider Demographics
NPI:1982888244
Name:BOUMA, LAWRENCE CURTIS (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:CURTIS
Last Name:BOUMA
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 1:12964 ROE RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1204
Mailing Address - Country:US
Mailing Address - Phone:206-780-2642
Mailing Address - Fax:
Practice Address - Street 1:12964 ROE RD NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1204
Practice Address - Country:US
Practice Address - Phone:206-780-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI113122300000X
WA4427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist