Maxime Bouvagnet, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019034281 Issued in IL

Practice address

4641 W Diversey Ave
Chicago, IL 60639-1828

Phone

(773) 692-4147

NPI assigned

May 30, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1295428803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 W WELLINGTON AVE # G",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606574014",
            "telephone_number": "312-493-0956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 W DIVERSEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391828",
            "telephone_number": "773-692-4147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUVAGNET",
        "first_name": "MAXIME",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-30",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019034281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine-Audrey Boutin, M.D.
• Andrew Stephen Boutsicaris
• Alexandra Boutsikakis
• Harold Joseph Boutte Jr., M.D.
• Rachel Leah Boutte
• Rae Marie Bouvin, D.C.
• Alisha Bouzaher, MD
• Davide Bova, MD
• Jodi Ann Bova, LCPC
• Joseph A Bova

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.