Individual
DR. SIDNEY LAWRENCE BOURGEOIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
800 IRVING AVENUE (160), SYRACUSE, NY 13210
(315) 425-2468
(315) 425-4415
Mailing address
800 IRVING AVENUE (160), SYRACUSE, NY 13210
(315) 425-2468
(315) 425-4415
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
056936
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22617
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
056936
NY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
22617
TX
Other
Enumeration date
05/30/2005
Last updated
07/28/2021
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