Nathan Gary Bourassa, DDS Valid NPI
Individual provider · General Practice Dentistry · Post Falls, ID
- NPI
- 1669662995
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- D-4076 (ID)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2007-08-01
- Last updated
- 2007-08-01
Practice location
105 E 10th Ave Ste B
Post Falls, ID 83854-5125
(208) 773-8388