Individual
JEAN PAUL BOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
25 LONG CREEK DR, SOUTH PORTLAND, ME 04106-2440
(207) 775-2072
Mailing address
25 LONG CREEK DR, SOUTH PORTLAND, ME 04106-2440
(207) 775-2072
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
21417
MA
1223G0001X
General Practice Dentistry
Primary
DEN4011
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA41490
HARVARD PILGRIM POS
—
01
—
X09241
DENTAL BLUE
—
Enumeration date
07/07/2006
Last updated
07/08/2007
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