Nathan Bourassa DDS PA

Primary specialty

DentistTaxonomy code 122300000X

License

D4076 Issued in ID

Legal business name

NATHAN BOURASSA DDS PA

Doing business as

Artisan Dental

Practice address

509 W Hanley Ave Ste 102
Coeur D Alene, ID 83815-8994

Phone

(208) 664-9506

Fax

(208) 665-1598

NPI assigned

Jun 6, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nathan Gary Bourassa, DDS

Title

President

Phone

(208) 664-9506

Specialties & licenses 1

Addresses

Other names 1

• Artisan Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1588077598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 W HANLEY AVE STE 102",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158994",
            "telephone_number": "208-664-9506",
            "fax_number": "208-665-1598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 W HANLEY AVE STE 102",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158994",
            "telephone_number": "208-664-9506",
            "fax_number": "208-665-1598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATHAN BOURASSA DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-06",
        "last_updated": "2014-06-06",
        "status": "A",
        "authorized_official_last_name": "BOURASSA",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-664-9506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D4076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Artisan Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.