Organization
REACHING OUT MINISTRIES
Active
Other names
Paradise Smiles Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNY WAYNE BOURGEOIS DDS (PRESIDENT/PRIMARY DENTAL PROVIDER)
(671) 646-2010
Entity
Organization
Contact information
Practice address
226 CHALAN SAN ANTONIO STE C, AMPARO'S BUSINESS CENTER, TAMUNING, GU 96913-3525
(671) 646-2010
(671) 646-2070
Mailing address
226 CHALAN SAN ANTONIO STE C, AMPARO'S BUSINESS CENTER, TAMUNING, GU 96913-3525
(671) 646-2010
(671) 646-2070
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
14605
TX
261QD0000X
Dental Clinic/Center
Primary
D927
GU
Other
Enumeration date
07/22/2009
Last updated
07/22/2009
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