Provider Demographics
NPI:1407516065
Name:BOUCREE & ASSOCIATES
Entity type:Organization
Organization Name:BOUCREE & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOUCREE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:202-744-3099
Mailing Address - Street 1:8555 16TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2802
Mailing Address - Country:US
Mailing Address - Phone:202-265-5910
Mailing Address - Fax:301-585-5901
Practice Address - Street 1:8555 16TH ST STE 404
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2802
Practice Address - Country:US
Practice Address - Phone:202-265-5910
Practice Address - Fax:301-585-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021233500Medicaid