Individual
DR. CARLOS BOU ASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
10590 ENDURING FREEDOM DRIVE, FORT DRUM, NY 13602-5005
(315) 772-6234
(315) 774-3558
Mailing address
10590 ENDURING FREEDOM DRIVE, FORT DRUM, NY 13602-5005
(315) 772-6234
(315) 774-3558
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
03622
NH
122300000X
Dentist
21826
MA
1223G0001X
General Practice Dentistry
Primary
22DI02299200
NJ
Other
Enumeration date
09/21/2006
Last updated
04/09/2015
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