Provider Demographics
NPI:1487734141
Name:DUFOUR, ANNE JOUCLA
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:JOUCLA
Last Name:DUFOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2325
Mailing Address - Country:US
Mailing Address - Phone:610-779-2222
Mailing Address - Fax:
Practice Address - Street 1:1050 BEN FRANKLIN HWY W
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1042
Practice Address - Country:US
Practice Address - Phone:610-385-1178
Practice Address - Fax:610-779-6162
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028998L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics