NPIMap

Organization Active NPI

Kelly Bouchard DMD PC

  • General Practice Dentistry
  • West Springfield, MA
National Provider Identifier
1821008681
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20552 Issued in MA
Legal business name
KELLY BOUCHARD DMD PC
Practice address
103 Van Deene Avenue
West Springfield, MA 01089
Phone
(413) 733-3019
Fax
(413) 788-7387
NPI assigned
Aug 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kelly Bouchard, DMDNPI 1316105307
Title
Owner President
Phone
(413) 733-3019

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 20552 MA Primary

Addresses

Primary practice location

103 Van Deene Avenue
West Springfield, MA 01089

Mailing address

103 Van Deene Avenue
West Springfield, MA 01089
Phone (413) 733-3019

National Provider Directory

National Provider Directory

Locations

103 Van Deene Ave
West Springfield, MA 01089
Phone (413) 733-3019

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821008681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 VAN DEENE AVENUE",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "01089",
            "telephone_number": "413-733-3019",
            "fax_number": "413-788-7387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 VAN DEENE AVENUE",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "01089",
            "telephone_number": "413-733-3019",
            "fax_number": "413-788-7387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY BOUCHARD DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOUCHARD",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "413-733-3019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.