Individual
DR. KENNETH WAYNE BOURGEOIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
226 CHALAN SAN ANTONIO STE C, TAMUNING, GU 96913-3525
(671) 646-2010
(671) 646-2070
Mailing address
226 CHALAN SAN ANTONIO STE C, TAMUNING, GU 96913-3525
(671) 646-2010
(671) 646-2070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
14605
TX
1223G0001X
General Practice Dentistry
Primary
D927
GU
Other
Enumeration date
07/22/2009
Last updated
07/22/2009
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