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General NPI Number Information
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NPI Number | 1962686030
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Entity Type | Individual
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Provider Name | STANLEY ANTHONY BOUCREE JR. DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 8555 16TH ST STE 404
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City | SILVER SPRING
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State | MD
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Zip | 20910
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Country | US
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Telephone | 202-265-5910
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Fax | 301-585-5901
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Provider Business Mailing Address
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Address Line | 8555 16TH STREET, STE. 404
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City | SILVER SPRING
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State | MD
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Zip | 20910
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Country | US
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Telephone | 202-265-5910
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Fax | 301-585-5901
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN5938
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15670
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD036903
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D71459
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License Number State | MD
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