Individual
DR. JERRI ANNE BOUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2300 JAMES ST, LAWRENCEVILLE, IL 62439-2089
(618) 943-5664
(618) 943-4037
Mailing address
2300 JAMES ST, LAWRENCEVILLE, IL 62439-2089
(618) 943-5664
(618) 943-4037
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019024088
IL
Other
Enumeration date
08/21/2006
Last updated
06/02/2015
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