Individual
DR. BRIAN LEE BOUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
315 E SAN MARNAN DR, WATERLOO, IA 50702-5837
(319) 235-6287
Mailing address
315 E SAN MARNAN DR, WATERLOO, IA 50702-5837
(319) 235-6287
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6490
IA
Other
Enumeration date
04/22/2009
Last updated
04/22/2009
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