DR. SIDNEY LAWRENCE BOURGEOIS D.D.S. NPI 1629071154

NPI Information

  • NPI: 1629071154
  • Provider Name: DR. SIDNEY LAWRENCE BOURGEOIS, D.D.S.
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 800 IRVING AVENUE (160)
    SYRACUSE, NY
    ZIP 13210
  • Phone: (315) 425-2468

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NPI Details

DR. Sidney Lawrence Bourgeois, D.D.S. is an oral and maxillofacial surgery dentist in Syracuse, NY. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Sidney Lawrence Bourgeois, D.D.S. NPI is 1629071154. 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:

800 IRVING AVENUE (160)
SYRACUSE, NY
ZIP 13210
Phone: (315) 425-2468
Fax: (315) 425-4415

The NPI 1629071154 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 5/30/2005 and was last updated on 7/28/2021.

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
11223S0112XDentistOral and Maxillofacial Surgery056936NEW YORKYes
21223S0112XDentistOral and Maxillofacial Surgery22617TEXASNo
3204E00000XOral & Maxillofacial Surgery22617TEXASNo
4204E00000XOral & Maxillofacial Surgery056936NEW YORKNo

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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