Individual
DR. ALEXANDER L BOURNIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1015 GROVE ST, MEADVILLE, PA 16335-2905
(814) 336-4304
Mailing address
PO BOX 65, 196 S SMITH ST, COCHRANTON, PA 16314-0065
(814) 425-3706
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS020436L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750346805
GROUP TYPE 2 NPI
PA
01
—
961361
BC BS NUMBER
PA
Enumeration date
03/29/2007
Last updated
07/08/2007
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