Individual
GARY BOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
12 STILLWATER AVE, BANGOR, ME 04401-3984
(207) 941-6550
(207) 973-3952
Mailing address
174 BANGOR RD, BENTON, ME 04901-3532
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
5535
ME
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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