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General NPI Number Information
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NPI Number | 1114490950
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Entity Type | Organization
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Legal Business Name | MARK BOURCIER DMD PLLC
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 33 SOUTHWICK ST
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City | FEEDING HILLS
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State | MA
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Zip | 01030-2023
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Country | US
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Telephone | 413-786-7555
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Fax | 413-786-7556
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Provider Business Mailing Address
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Address Line | 134 COLONIAL DR
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City | LUDLOW
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State | MA
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Zip | 01056-1172
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Country | US
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Telephone | 413-657-7237
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MARK BOURCIER
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Credential | DMD
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Telephone | 413-657-7237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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