Provider Demographics
NPI:1245580018
Name:BASHAR AL KHOURI,PA
Entity Type:Organization
Organization Name:BASHAR AL KHOURI,PA
Other - Org Name:BRIGHT SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-681-8151
Mailing Address - Street 1:121 W WINDHORST RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2434
Mailing Address - Country:US
Mailing Address - Phone:813-681-8151
Mailing Address - Fax:813-643-7977
Practice Address - Street 1:121 W WINDHORST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2434
Practice Address - Country:US
Practice Address - Phone:813-681-8151
Practice Address - Fax:813-643-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 132571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty