KELLY BOUCHARD DMD PC (NPI# 1821008681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821008681 |
| Entity Type | Organization |
| Organization Name | KELLY BOUCHARD DMD PC |
| Practice Address |
103 Van Deene Avenue West Springfield MA 01089 |
| Practice Telephone | 4137333019 |
| Practice Fax Number | 4137887387 |
| Mailing Telephone | 4137333019 |
| Mailing Fax Number | 4137887387 |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. KELLY BOUCHARD (OWNER PRESIDENT) |
| Authorized Official Telephone | 4137333019 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
20552 | MA | Dental Providers |
| Street Address |
103 VAN DEENE AVENUE |
| City | WEST SPRINGFIELD |
| State | MA |
| Zip Code | 01089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366040990 | Konrad Syrek | Behavioral Analyst | 1472 Riverdale St. Suite A, West Springfield, MA 01089 | 2020-10-15 |
| 1861099335 | Vanna Leang | Behavioral Analyst | 1472 Riverdale St, Suite A, West Springfield, MA 01089 | 2020-10-07 |
| 1215534755 | Malakie Berry | Behavioral Analyst | 1472 Riverdale St., Suite A, West Springfield, MA 01089 | 2020-10-07 |
| 1952800930 | Nicole Coughlin | Social Worker | 103 Myron St. Suite A, West Springfield, MA 01089 | 2018-02-06 |
| 1679017156 | Tender Care Helping Hands LLC | Home Health | 1434 Memorial Ave, Westspringfield, MA 01089 | 2016-12-19 |
| 1154736130 | Mikin Patel | Dentist | 235b Memorial Ave, West Springfield, MA 01089 | 2014-06-27 |
| 1881029312 | Melinda A Koblosh | Physical Therapist | 1111 Elm St., Suite 9, West Springfield, MA 01089 | 2013-09-03 |
| 1316379852 | Jessica C Marquez | Social Worker | 204 Wayside Ave, West Springfield, MA 01089 | 2013-08-07 |
| 1114360112 | Center for Human Development | In Home Supportive Care | 247 Park St, West Springfield, MA 01089 | 2013-04-10 |
| 1336421395 | John L. O'neill | Social Worker | 103 Myron Street Suite A, West Springfield, MA 01089 | 2011-09-15 |
| Find all providers in zip 01089 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154736130 | Mikin Patel | Dentist | 235b Memorial Ave, West Springfield, MA 01089 | 2014-06-27 |
| 1821250820 | Vijay Bhaskar Reddy Gaddam | Dentist | 1073 Riverdale St, West Springfield, MA 01089-4614 | 2008-06-30 |
| 1316105307 | Kelly Marie Bouchard | Dentist | 103 Van Deene Ave, West Springfield, MA 01089-3200 | 2008-05-28 |
| 1255460945 | Robert Michael Salem | Dentist | 75 Van Deene Ave Ste 102, West Springfield, MA 01089-3216 | 2007-03-05 |
| 1215007539 | Buddy Denison | Dentist | 75 Vandeene Ave, Suite 202, West Springfield, MA 01089-3283 | 2006-11-08 |
| 1568476927 | Lee Hood | Dentist | 1284 Elm Street, West Springfield, MA 01089 | 2006-07-28 |
| 1316935448 | Gary Frank Circosta | Dentist | 93 Van Deene Ave, West Springfield, MA 01089-3236 | 2005-10-12 |
| 1134612252 | Matthew Roy Schultz | Dentist | 935 Riverdale St, West Springfield, MA 01089 | 2018-06-13 |
| 1538561931 | Dental-west, LLC | Dentist | 171 Park Ave, 102, West Springfield, MA 01089-3382 | 2014-09-17 |
| 1699187427 | Cole Gary Archambault | Dentist | 1284 Elm St, West Springfield, MA 01089-1827 | 2014-05-28 |
| Find all providers in WEST SPRINGFIELD | ||||
| City | WEST SPRINGFIELD |
| Zip Code | 01089 |
Please comment or provide details below to improve the information on KELLY BOUCHARD DMD PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.