# NATHAN BOURASSA DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Artisan Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588077598
- **Authorized official:** DR. NATHAN GARY BOURASSA DDS (PRESIDENT)
- **Authorized official phone:** (208) 664-9506

## Contact information

- **Practice address:** 509 W HANLEY AVE STE 102, COEUR D ALENE, ID 83815-8994
- **Practice address phone:** (208) 664-9506
- **Practice address fax:** (208) 665-1598
- **Mailing address:** 509 W HANLEY AVE STE 102, COEUR D ALENE, ID 83815-8994
- **Mailing address phone:** (208) 664-9506
- **Mailing address fax:** (208) 665-1598

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4076 | ID | Yes |

## Other

- **Enumeration date:** 06/06/2014
- **Last updated:** 06/06/2014