MEDICARE: DR. AARON THOMAS BOUCHER D.D.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
1	1223G0001X	General Practice Dentistry	18691	MI

General Provider Information

NPI Number	:	1194819052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON THOMAS BOUCHER D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 118
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-0118
Country	:	US
Telephone Number	:	616-527-3050
Fax Number	:	616-527-3667

Provider Business Practice Location Address
First Line	:	340 LOVELL ST
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-9706
Country	:	US
Telephone Number	:	616-527-3050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/30/2022

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Directions to “ DR. AARON THOMAS BOUCHER D.D.S.” Practice Location

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