Nathan Gary Bourassa, DDS
Individual provider Active NPI General Practice Dentistry · Post Falls, ID
NPI 1669662995 · NPPES record last updated Aug 1, 2007
Key facts
- NPI
- 1669662995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D-4076 (ID)
- Practice address
- 105 E 10TH Ave Ste B
Post Falls, ID 83854-5125 - Phone
- (208) 773-8388
- Fax
- (208) 777-0346
- NPI assigned
- Aug 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-4076 | ID | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Toothacres Dental Inc. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D-4076 | ID | Yes |
Addresses
Primary practice location
105 E 10TH Ave Ste B
Post Falls, ID 83854-5125
Mailing address
105 E 10TH Ave Ste B
Post Falls, ID 83854-5125
Phone (208) 773-8388
Other providers in Post Falls, ID
- Kate Melanie Bolin
- Belina Bolser
- Meeka J Bond
- Mark P Borsheim
- Ivonne Olay Boujaoude
- Samantha Patricia Bourassa
- Drea Marie Bowen I
- Joseph Marshall Bowen
- David Roman Boyce
- Karen Boyd
All providers in Post Falls, ID · General Practice Dentistry in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.