Provider Demographics
NPI:1366644221
Name:BASSIRI & HOSSEINI D.D.S., INC.
Entity Type:Organization
Organization Name:BASSIRI & HOSSEINI D.D.S., INC.
Other - Org Name:BONITA SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KOROUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-421-9070
Mailing Address - Street 1:1558 E H ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2018
Mailing Address - Country:US
Mailing Address - Phone:619-421-9070
Mailing Address - Fax:
Practice Address - Street 1:1558 E H ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-2018
Practice Address - Country:US
Practice Address - Phone:619-421-9070
Practice Address - Fax:619-421-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty