Colleen Bouffard, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

007407 Issued in CT

Practice address

438 Main St
Suite 204
Middletown, CT 06457-3396

Phone

(888) 964-6681

Fax

(888) 662-0859

NPI assigned

Sep 17, 2016

Last updated

Sep 17, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Colleen Gagne Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1474070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474070400000",
    "number": "1528516614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 WORCESTER ST",
            "address_2": "SUITE 130",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024823717",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 MAIN ST",
            "address_2": "SUITE 204",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573396",
            "telephone_number": "888-964-6681",
            "fax_number": "888-662-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUFFARD",
        "first_name": "COLLEEN",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-17",
        "last_updated": "2016-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CT",
            "license": "007407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "GAGNE",
            "credential": "RDH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jamie Bordner, PHARMD
• John J Borkowski, M.D.
• Susan Boronese, PHARM.D.
• Yevgeniya Borovinskaya, DO
• Correne L Boucher, MD
• Alisha Bourassa
• Ryan Boutin, DO
• Jane Bouvier, LCSW
• Stephanie Jeanne P I I Lani Boyce
• Christina Boyle

• Dental Hygienist in Middletown, CT
• Providers in Middletown, CT by specialty
• Dental Hygienist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2016; 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.