Organization
NATHAN BOURASSA DDS PA
Active
Other names
Artisan Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN GARY BOURASSA DDS (PRESIDENT)
(208) 664-9506
Entity
Organization
Contact information
Practice address
509 W HANLEY AVE STE 102, COEUR D ALENE, ID 83815-8994
(208) 664-9506
(208) 665-1598
Mailing address
509 W HANLEY AVE STE 102, COEUR D ALENE, ID 83815-8994
(208) 664-9506
(208) 665-1598
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4076
ID
Other
Enumeration date
06/06/2014
Last updated
06/06/2014
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