Healthcare Provider Details

I. General information

NPI: 1427708049
Provider Name (Legal Business Name): PAULA MARIE BOURASSA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 03/26/2022
Certification Date: 03/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 ASHEVILLE HWY
KNOXVILLE TN
37914-4252
US

IV. Provider business mailing address

4819 SKYLINE DR
KNOXVILLE TN
37914-4216
US

V. Phone/Fax

Practice location:
  • Phone: 548-525-6995
  • Fax:
Mailing address:
  • Phone: 603-533-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number9594
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: