| Artisan Dental | |
|
509 W Hanley Ave Ste 102 Coeur D Alene ID 83815-8994 | |
| (208) 664-9506 | |
| (208) 665-1598 |
| Full Name | Artisan Dental |
|---|---|
| Speciality | Dentist |
| Location | 509 W Hanley Ave Ste 102, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Nathan Gary Bourassa (PRESIDENT) |
| Authorized Official Contact | 2086649506 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Artisan Dental 509 W Hanley Ave Ste 102 Coeur D Alene ID 83815-8994 Ph: (208) 664-9506 | Artisan Dental 509 W Hanley Ave Ste 102 Coeur D Alene ID 83815-8994 Ph: (208) 664-9506 |
| NPI Number | 1588077598 |
|---|---|
| Provider Enumeration Date | 06/06/2014 |
| Last Update Date | 06/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588077598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D4076 (Idaho) | Primary |
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