Individual
BENJAMIN BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3989 CASCADE RD SE, GRAND RAPIDS, MI 49546-2178
(616) 459-7171
(616) 459-7181
Mailing address
3989 CASCADE RD SE, GRAND RAPIDS, MI 49546-2178
(616) 459-7171
(616) 459-7181
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901602468
MI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2901602468
MI
Other
Enumeration date
05/09/2023
Last updated
09/22/2025
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