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General NPI Number Information
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NPI Number | 1346406303
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Entity Type | Organization
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Legal Business Name | MARCEL T. BOUGHER, DDS, INC
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 6280 JACKSON DRIVE SUITE 1
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City | SAN DIEGO
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State | CA
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Zip | 92119
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Country | US
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Telephone | 619-464-2852
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Fax |
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Provider Business Mailing Address
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Address Line | 6280 JACKSON DRIVE SUITE 1
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City | SAN DIEGO
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State | CA
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Zip | 92119
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Country | US
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Telephone | 619-464-2852
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARCEL TODD BOUGHER
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Credential | D.D.S.
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Telephone | 619-708-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 47233
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License Number State | CA
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