Provider Demographics
NPI:1427708049
Name:BOURASSA, PAULA MARIE (RDH)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:MARIE
Last Name:BOURASSA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-4216
Mailing Address - Country:US
Mailing Address - Phone:603-533-8688
Mailing Address - Fax:
Practice Address - Street 1:4820 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-4252
Practice Address - Country:US
Practice Address - Phone:548-525-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9594124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist