Individual
GEORGE BOUKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4526 GLEN EAGLE DR, BRECKSVILLE, OH 44141-2934
(336) 337-8492
Mailing address
160 E ERIE AVE, PHILADELPHIA, PA 19134-1011
(215) 427-5213
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30.027032
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/22/2021
Last updated
06/29/2023
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