Individual
THADDEUS STANICE BOUCREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., DDS
Contact information
Practice address
535 SYCAMORE AVE, SHREWSBURY, NJ 07702
(732) 741-0970
(732) 747-2606
Mailing address
535 SYCAMORE AVE, SHREWSBURY, NJ 07702-4224
(732) 741-0970
(732) 747-2606
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
25MA10083000
NJ
208200000X
Plastic Surgery Physician
Primary
25MA10083000
NJ
208200000X
Plastic Surgery Physician
301972
NY
Other
Enumeration date
07/15/2008
Last updated
09/15/2025
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