Provider Demographics
NPI:1295842904
Name:BASSIRI, SASSAN (DDS)
Entity Type:Individual
Prefix:
First Name:SASSAN
Middle Name:
Last Name:BASSIRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:642 S MAIN ST
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021
Mailing Address - Country:US
Mailing Address - Phone:336-983-0095
Mailing Address - Fax:336-983-0588
Practice Address - Street 1:642 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-983-0095
Practice Address - Fax:336-983-0588
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902NUMedicaid