Individual
NICHOLAS JAMES BOURNIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901015573
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3159052
—
MI
05
—
3203473
—
MI
01
—
970F31085
BCBSM
MI
01
—
NB015573
LICENSE NUMBER
MI
Enumeration date
11/16/2005
Last updated
12/06/2023
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