Individual provider · Type 1 NPI
Sidney Lawrence Bourgeois Jr., DDS
Oral and Maxillofacial Surgery (Dentist) · Syracuse, NY
NPI number
1629071154
Active
Practice location
800 Irving Avenue (160)
Syracuse, NY 13210
Fax (315) 425-4415
Other practice locations
- Syracuse Oral And Maxillofacial Surgery, 578 Seneca Street, Oneida, NY 13421 · (315) 363-8233
- Syracuse Oral And Maxillofacial Surgery, 516 East Genesee Street, Fayetteville, NY 13066 · (315) 637-4476
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 22617 (TX) |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 056936 (NY) |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 22617 (TX) |
| Oral and Maxillofacial Surgery (Dentist) Primary | 1223S0112X | 056936 (NY) |
Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes 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.
About NPI 1629071154
Sidney Lawrence Bourgeois Jr., DDS's National Provider Identifier is 1629071154, issued on May 30, 2005. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Syracuse, NY. The record was last updated on Jul 28, 2021.