Provider Demographics
NPI:1669677746
Name:BASHOUR, BASSIMA (BASSIMA BASHOUR)
Entity Type:Individual
Prefix:DR
First Name:BASSIMA
Middle Name:
Last Name:BASHOUR
Suffix:
Gender:F
Credentials:BASSIMA BASHOUR
Other - Prefix:
Other - First Name:BASSIMA
Other - Middle Name:
Other - Last Name:CONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BASSIMA BASHOUR
Mailing Address - Street 1:70 CONANT RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1035
Mailing Address - Country:US
Mailing Address - Phone:617-981-9952
Mailing Address - Fax:
Practice Address - Street 1:70 CONANT RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-3131
Practice Address - Country:US
Practice Address - Phone:617-981-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist