Healthcare Provider Details

I. General information

NPI: 1821907833
Provider Name (Legal Business Name): FREDERICK W BOURGEOIS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 N HIGH ST
COLUMBUS OH
43214-1117
US

IV. Provider business mailing address

5400 N HIGH ST
COLUMBUS OH
43214-1117
US

V. Phone/Fax

Practice location:
  • Phone: 614-436-2817
  • Fax: 614-436-3954
Mailing address:
  • Phone: 614-436-2817
  • Fax: 614-436-3954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIAN BOURGEOIS
Title or Position: TREASURER
Credential: DDS
Phone: 614-436-2817