Provider Demographics
NPI:1548260334
Name:BOURQUEIN, ROBERT KEMP (DDS MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEMP
Last Name:BOURQUEIN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 HWY 16 S
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4472
Mailing Address - Country:US
Mailing Address - Phone:830-990-0333
Mailing Address - Fax:830-990-9200
Practice Address - Street 1:1031 HWY 16 S
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4472
Practice Address - Country:US
Practice Address - Phone:830-990-0333
Practice Address - Fax:830-990-9200
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics