Provider Demographics
NPI:1609036789
Name:BASHIRI, S M HASSAN (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:S M HASSAN
Middle Name:
Last Name:BASHIRI
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72088
Mailing Address - Country:US
Mailing Address - Phone:501-884-3200
Mailing Address - Fax:
Practice Address - Street 1:203 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD BAY
Practice Address - State:AR
Practice Address - Zip Code:72088
Practice Address - Country:US
Practice Address - Phone:501-884-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist