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DR. SIDNEY LAWRENCE BOURGEOIS JR. D.D.S.
NPI 1629071154
Dentist - Oral and Maxillofacial Surgery in Syracuse, NY

Active since May 30, 2005PECOS Enrolled
800 IRVING AVENUE (160), SYRACUSE, NY 13210(315) 425-2468(315) 425-4415 Get Directions Write a Review

NPPES record last updated: July 28, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 28, 2021, Jul 13, 2019 (2 updates tracked since 2019).

About Dr. Sidney Lawrence Bourgeois Jr. D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SIDNEY LAWRENCE BOURGEOIS JR. D.D.S. (NPI 1629071154) is an individual oral and maxillofacial surgery provider in Syracuse, New York, licensed in New York (056936) and active in the NPI registry since May 2005. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1629071154
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. SIDNEY LAWRENCE BOURGEOIS JR.Credential: D.D.S.
Location Address800 IRVING AVENUE (160)Syracuse, NY 13210
Mailing Address800 Irving Avenue (160)Syracuse, NY 13210 · (315) 425-2468 · Fax (315) 425-4415
Phone(315) 425-2468
Fax(315) 425-4415
Sole ProprietorNo
Enumeration DateMay 30, 2005
Last NPPES UpdateJuly 28, 20212 updates tracked since enumeration
NPPES CertifiedJuly 3, 2021
✔ NPI 1629071154 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Licenses✔ Licensed in NY · 056936✔ Licensed in TX · 22617
Definition

An oral and maxillofacial surgery dentist specialized in 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.

Also ListedOral & Maxillofacial SurgeryTaxonomy 204E00000X · License 22617 (TX), 056936 (NY)
800 IRVING AVENUE (160), Syracuse, NY 13210
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Secondary Practice Locations 2

Location 1Syracuse Oral and Maxillofacial Surgery, 578 Seneca StreetOneida, NY 13421 · Phone (315) 363-8233 · Fax (315) 363-5043
Location 2Syracuse Oral and Maxillofacial Surgery, 516 East Genesee StreetFayetteville, NY 13066 · Phone (315) 637-4476 · Fax (315) 637-1261

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Sidney Lawrence Bourgeois Jr. D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13210 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.93 typical visit price
range $54.87 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.57 typical visit price
range $17.54 – $136.14
Typical copayment $17.14 (range $4.38 – $34.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions

What is Sidney Bourgeois's NPI number?

The NPI number assigned to this healthcare provider is 1629071154, enumerated as an "individual" on May 30, 2005.

Where is the provider located?

The provider is located at 800 IRVING AVENUE (160) SYRACUSE, NY 13210 and the phone number is (315) 425-2468.

What is the provider's specialty?

Dentist with taxonomy code 1223S0112X and a focus in Oral and Maxillofacial Surgery.