Individual
DR. LIBERTY ANN BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7040 N PORT WASHINGTON RD, GLENDALE, WI 53217-3838
(414) 351-6010
Mailing address
4037 N DOWNER AVE, SHOREWOOD, WI 53211-2127
(414) 418-2280
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6297-15
WI
Other
Enumeration date
07/30/2008
Last updated
07/30/2008
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