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David R. Bourque, D.D.S. , P.C.

Dentist, General Practice in Cooperstown, NY. Organization (NPI-2).

NPI number1194929596
StatusActive
Last updated in NPPESJun 1, 2010

Details

NPI
1194929596
Entity type
Organization (NPI-2)
Legal business name
David R. Bourque, D.D.S. , P.C.
Organization subpart
No
Enumeration date
Jun 12, 2007
Last updated
Jun 1, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice37469NYYes

Practice location

6 Doubleday Court
Northern Catskill Dental Associates
Cooperstown, NY 13326-1223

Phone 607-547-2313 · Fax 607-547-6251

Mailing address

3184 Woodland Ct N
N Tonawanda, NY 14120-1153

Phone 716-693-1971

Authorized official

David Robert Bourque
President
7166931971

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