MEDICARE: DR. NORMAN J. BOUCHARD 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	122300000X	Dentist	003463	DC

General Provider Information

NPI Number	:	1265647077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN J. BOUCHARD D.D.S.

Provider Business Mailing Address
First Line	:	412 1ST ST SE
Second Line	:	2ND FLOOR, REAR BLDG
City	:	WASHINGTON
State	:	DC
Zip	:	20003-1804
Country	:	US
Telephone Number	:	202-863-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 1ST ST SE
Second Line	:	2ND FLOOR, REAR BLDG
City	:	WASHINGTON
State	:	DC
Zip	:	20003-1804
Country	:	US
Telephone Number	:	202-863-1600
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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