Provider Demographics
NPI:1407978760
Name:BASORA, THOMAS AJ (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:AJ
Last Name:BASORA
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 1:340 PYRAMID WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5051
Mailing Address - Country:US
Mailing Address - Phone:775-359-3336
Mailing Address - Fax:775-359-0755
Practice Address - Street 1:340 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5051
Practice Address - Country:US
Practice Address - Phone:775-359-3336
Practice Address - Fax:775-359-0755
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV44811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice