Provider Demographics
NPI:1679629307
Name:BASH, IRA EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:EDWIN
Last Name:BASH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIGHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1208
Mailing Address - Country:US
Mailing Address - Phone:201-568-7123
Mailing Address - Fax:
Practice Address - Street 1:439 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2211
Practice Address - Country:US
Practice Address - Phone:201-861-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0090981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0456501OtherUNISYS
NJ0012806OtherDORAL
NJ1024469OtherHORIZON NJ HEALTH