Provider Demographics
NPI:1538143623
Name:BASSI, ISHA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISHA
Middle Name:B
Last Name:BASSI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:ISHA
Other - Middle Name:B
Other - Last Name:BASSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2277 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3320
Mailing Address - Country:US
Mailing Address - Phone:815-546-4269
Mailing Address - Fax:
Practice Address - Street 1:2241 THEODORE ST
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1881
Practice Address - Country:US
Practice Address - Phone:815-546-4269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190260791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019026079OtherLICENSE