Individual
DR. NATHAN GARY BOURASSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
105 E 10TH AVE STE B, POST FALLS, ID 83854-5125
(208) 773-8388
(208) 777-0346
Mailing address
105 E 10TH AVE STE B, POST FALLS, ID 83854-5125
(208) 773-8388
(208) 777-0346
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4076
ID
Other
Enumeration date
08/01/2007
Last updated
08/01/2007
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