GARY BOUDREAU LD NPI 1467996330

NPI Information

  • NPI: 1467996330
  • Provider Name: GARY BOUDREAU, LD
  • Classification: Denturist - 122400000X
  • Entity Type: Individual
  • Address: 12 STILLWATER AVE
    BANGOR, ME
    ZIP 04401
  • Phone: (207) 941-6550

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NPI Details

Gary Boudreau, LD is a denturist in Bangor, ME. The provider is a denturist is a licensed professional that serves patients with removable dental prosthetic oral health needs. A licensed denturist is trained in removable dental prosthetics and the fabrication of such devices. Gary Boudreau, LD NPI is 1467996330. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

12 STILLWATER AVE
BANGOR, ME
ZIP 04401-984
Phone: (207) 941-6550
Fax: (207) 973-3952

The enumeration date for this NPI number is 12/13/2016 and was last updated on 12/13/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1122400000XDenturist5535MAINEYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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