Individual
FLOYD FREDICK BOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3745 GEIST RD, FAIRBANKS, AK 99709-3548
(907) 479-2208
(907) 474-8488
Mailing address
3745 GEIST RD, FAIRBANKS, AK 99709-3548
(907) 479-2208
(907) 474-8488
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
404
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00008699
BANNER HEATH
AK
01
—
0005931238
AETNA
AK
01
—
207728100000
PREMERA BLUE CROSS
AK
01
—
825962
UNITED CONCORDIA
AK
01
—
920074602F001
BLUE CROSS FEDERAL
AK
01
—
93422077280001
PREMERA BLUE CROSS MEDICA
AK
Enumeration date
02/27/2008
Last updated
02/27/2008
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