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General NPI Number Information
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NPI Number | 1164091369
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Entity Type | Individual
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Provider Name | CASSIDY SLOAN BOUDREAU DMD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 2836 LAKESHORE PKWY
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City | BIRMINGHAM
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State | AL
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Zip | 35211-5500
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Country | US
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Telephone | 205-434-2781
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Fax |
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Provider Business Mailing Address
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Address Line | 416 KENILWORTH DR
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City | BIRMINGHAM
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State | AL
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Zip | 35209-5414
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Country | US
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Telephone | 334-398-1077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D-0006916-C1
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License Number State | AL
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