Dr. Richard George Boudreau
Oral and Maxillofacial Surgeon
13160 Mindanao Way Suite 120
Marina del Rey
, California 90292-6358
Dr. Richard George Boudreau
Oral and Maxillofacial Surgeon
13160 Mindanao Way Suite 120
Marina del Rey
, California 90292-6358
(310) 822-6825
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About
Features
Specialties
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Richard George Boudreau
- 13160 Mindanao Way Suite 120
- Marina Del Rey, CA
- Zip : 90292-6358
- Fax : (310) 822-6825
- Phone : (310) 822-6161
Second Address
- Dr. Richard George Boudreau
- 13160 Mindanao Way Suite 120
- Marina Del Rey, CA
- Zip : 90292-6358
- Fax : (310) 822-6825
- Phone : (310) 822-6161
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | D21852 | CA |
National Provider Identifier
| NPI | 1003952334 |
|---|---|
| Provider Name | Dr. Richard George Boudreau |
| First Address | Marina Del Rey, CA 90292-6358 |
| Second Address | Marina Del Rey, CA 90292-6358 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/01/2007 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.