Provider Demographics
NPI:1861975989
Name:BOUCHER, STEVEN WILFRED-EARLE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WILFRED-EARLE
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 GAUDETTE DR
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-4528
Mailing Address - Country:US
Mailing Address - Phone:508-567-2573
Mailing Address - Fax:
Practice Address - Street 1:38 GAUDETTE DR
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-4528
Practice Address - Country:US
Practice Address - Phone:508-567-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23745122300000X
MADN1858123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist