Provider Demographics
NPI:1346768777
Name:AL-RAWI, BASSAM TAHA (DMD, MS)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:TAHA
Last Name:AL-RAWI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 BURTON DR APT C
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5010
Mailing Address - Country:US
Mailing Address - Phone:512-766-6990
Mailing Address - Fax:
Practice Address - Street 1:2500 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080
Practice Address - Country:US
Practice Address - Phone:530-934-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA043858122300000X
CA108150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist