Individual
MISS BRANDI LEA BOUSHEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1599 J ST BLDG 109A, GFAFB, ND 58205-6306
(701) 747-5393
Mailing address
1599 J ST BLDG 109A, GFAFB, ND 58205-6306
(701) 747-5393
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1160
ND
Other
Enumeration date
03/21/2011
Last updated
03/21/2011
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