Provider Demographics
NPI:1194819052
Name:BOUCHER, AARON THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:THOMAS
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-0118
Mailing Address - Country:US
Mailing Address - Phone:616-527-3050
Mailing Address - Fax:616-527-3667
Practice Address - Street 1:340 LOVELL ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-9706
Practice Address - Country:US
Practice Address - Phone:616-527-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI186911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18691OtherMICHIGAN STATE DENTAL LIC