Provider Demographics
NPI:1689843252
Name:BOUSE, FLOYD FREDICK (DDS)
Entity type:Individual
Prefix:
First Name:FLOYD
Middle Name:FREDICK
Last Name:BOUSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 GEIST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3548
Mailing Address - Country:US
Mailing Address - Phone:907-479-2208
Mailing Address - Fax:907-474-8488
Practice Address - Street 1:3745 GEIST RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3548
Practice Address - Country:US
Practice Address - Phone:907-479-2208
Practice Address - Fax:907-474-8488
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0005931238OtherAETNA
AK920074602F001OtherBLUE CROSS FEDERAL
AK93422077280001OtherPREMERA BLUE CROSS MEDICA
AK00008699OtherBANNER HEATH
AK825962OtherUNITED CONCORDIA
AK207728100000OtherPREMERA BLUE CROSS