Provider Demographics
NPI:1063532059
Name:BOUCREE, STANLEY A SR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:BOUCREE
Suffix:SR
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:8555 16TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2816
Mailing Address - Country:US
Mailing Address - Phone:301-585-5900
Mailing Address - Fax:301-585-5901
Practice Address - Street 1:8555 16TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2816
Practice Address - Country:US
Practice Address - Phone:301-585-5900
Practice Address - Fax:301-585-5901
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCDEN23331223S0112X, 122300000X
MD41391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021233500Medicaid
DC085960868Medicaid