Bryan Bouchard, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN5140 Issued in ME

Practice address

700 Mount Hope Ave Ste 610
Bangor, ME 04401-5673

Phone

(207) 945-5952

NPI assigned

May 21, 2024

Sex

Male

Sole proprietor

No

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brandon Jolley DDS PA LLC

  • General Practice Dentistry
  • Bangor, ME
  • NPI 1104691096

  General Practice

  NPD
• Frederick a. Port, DMD & Greg S. Solomon, DDS, PA

  • General Practice Dentistry
  • Bangor, ME
  • NPI 1972513190

  General Practice

  NPD (past)

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

{
    "created_epoch": "1716249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1316786148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "592 MUDGETT RD",
            "city": "LEVANT",
            "state": "ME",
            "postal_code": "044564146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MOUNT HOPE AVE STE 610",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015673",
            "telephone_number": "207-945-5952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHARD",
        "first_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-21",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DEN5140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nadine N Bos, DO
• Randy A Bosquet Jr., RPH
• Martina Pauline Bosse, DPT
• Lynea Elizabeth Bost, LCPC
• Ryan Bou Said, MD
• Kylee Ann Bouchard, LCSW
• Matthew Joseph Bouchard, D.P.T.
• Kati Lyn Boucher, PMHNP-BC
• Whitney Boucher, LMSW-CC
• Gary Boudreau, LD

• All providers in Bangor, ME
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; 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.