Provider Demographics
NPI:1063933794
Name:BISSONNETTE, CAROLINE (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:BISSONNETTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12365 RUE CREVIER
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H4K1R3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12365 RUE CREVIER
Practice Address - Street 2:
Practice Address - City:MONTREAL
Practice Address - State:QUEBEC
Practice Address - Zip Code:H4K1R3
Practice Address - Country:CA
Practice Address - Phone:614-620-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0038101223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology