Frederick M Bourgeois, DMD
Individual provider Active NPI Dentist · Pelham, NH
NPI 1437229093 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1437229093
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3390 (NH)
- Practice address
- 43 Bridge St
Pelham, NH 03076 - Phone
- (603) 635-2151
- Fax
- (603) 635-9924
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3390 | NH | MD | Dentist |
| 17891 | MA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Randazzo Dental Associates | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 17891 | MA | |
| Dentist | 122300000X | 3390 | NH | Yes |
Addresses
Primary practice location
43 Bridge St
Pelham, NH 03076
Mailing address
15 Iron Horse Dr Apt G310
Bedford, NH 03110
Phone (603) 606-1181
Other providers in Pelham, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.