Individual
DR. TIMOTHY JAMES BOURESSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
500 W 3RD ST, POB 96, KIMBERLY, WI 54136-1305
(920) 788-4201
Mailing address
500 W 3RD ST, POB 96, KIMBERLY, WI 54136-1305
(920) 788-4201
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3929
WI
Other
Enumeration date
10/10/2007
Last updated
10/10/2007
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