Provider Demographics
NPI:1528232246
Name:BASHAM, ANNE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:R
Last Name:BASHAM
Suffix:
Gender:F
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 965
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-0965
Mailing Address - Country:US
Mailing Address - Phone:304-267-2928
Mailing Address - Fax:
Practice Address - Street 1:1226 SHEPHERDSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25402
Practice Address - Country:US
Practice Address - Phone:304-267-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist