Provider Demographics
NPI:1467181123
Name:BUTTO, BASSAM
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:
Last Name:BUTTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BASSAM
Other - Middle Name:
Other - Last Name:FARID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 HUDSON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:551-900-6200
Mailing Address - Fax:
Practice Address - Street 1:140 MARKET ST FL 2
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1471
Practice Address - Country:US
Practice Address - Phone:973-742-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02987000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist