Provider Demographics
NPI:1427261734
Name:BOURASSA, WILLIAM L (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:BOURASSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:30 ALGONQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5528
Mailing Address - Country:US
Mailing Address - Phone:978-685-4055
Mailing Address - Fax:978-685-2040
Practice Address - Street 1:555 TURNPIKE ST
Practice Address - Street 2:SUITE 51
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5923
Practice Address - Country:US
Practice Address - Phone:978-685-4055
Practice Address - Fax:978-685-2040
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA123321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry