1962686030 NPI number — DR. STANLEY ANTHONY BOUCREE JR. DDS, MD

Table of content: DR. STANLEY ANTHONY BOUCREE JR. DDS, MD (NPI 1962686030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962686030 NPI number — DR. STANLEY ANTHONY BOUCREE JR. DDS, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUCREE
Provider First Name:
STANLEY
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DDS, MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962686030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8555 16TH STREET, STE. 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-265-5910
Provider Business Mailing Address Fax Number:
301-585-5901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8555 16TH ST STE 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-265-5910
Provider Business Practice Location Address Fax Number:
301-585-5901
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DEN5938 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 15670 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: MD036903 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: D71459 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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