Provider Demographics
NPI:1619399151
Name:HODA IMENI BASSIRI, D.D.S., P.A.
Entity Type:Organization
Organization Name:HODA IMENI BASSIRI, D.D.S., P.A.
Other - Org Name:FUSION DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HODA
Authorized Official - Middle Name:IMENI
Authorized Official - Last Name:BASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-977-7480
Mailing Address - Street 1:6400 CREEDMOOR RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4481
Mailing Address - Country:US
Mailing Address - Phone:919-977-7480
Mailing Address - Fax:919-977-7481
Practice Address - Street 1:6400 CREEDMOOR RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3600
Practice Address - Country:US
Practice Address - Phone:919-977-7480
Practice Address - Fax:919-977-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty