# DR. SIDNEY LAWRENCE BOURGEOIS JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629071154
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 056936 | NY | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22617 | TX | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 056936 | NY | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 22617 | TX | — |

## Other

- **Enumeration date:** 05/30/2005
- **Last updated:** 07/28/2021