Individual
LARRY G BOURDEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
510 MAIN ST, NORWAY, MI 49870
(906) 563-9291
Mailing address
PO BOX 162, NORWAY, MI 49870-0162
(906) 563-9291
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D120190
MI
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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