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NPI Code Detail

MEDICARE: DR. STANLEY A BOUCREE SR. D.D.S., M.S.

MEDICARE:  DR. STANLEY A BOUCREE SR. D.D.S., M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)DEN2333DC
21223S0112XOral and Maxillofacial Surgery (Dentist)4139MD
3122300000XDentistDEN2333DC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063532059
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STANLEY A BOUCREE SR. D.D.S., M.S.
Provider Business Mailing Address
First Line : 8555 16TH ST
Second Line : SUITE 404
City : SILVER SPRING
State : MD
Zip : 20910-2816
Country : US
Telephone Number : 301-585-5900
Fax Number : 301-585-5901
Provider Business Practice Location Address
First Line : 8555 16TH ST
Second Line : SUITE 404
City : SILVER SPRING
State : MD
Zip : 20910-2816
Country : US
Telephone Number : 301-585-5900
Fax Number : 301-585-5901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2007
Last Update Date : 04/25/2024

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Directions to “ DR. STANLEY A BOUCREE SR. D.D.S., M.S.” Practice Location

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