Provider Demographics
NPI:1790307346
Name:BASSERI, PARSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARSA
Middle Name:
Last Name:BASSERI
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 1:1 SOPHIE CT
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7961
Mailing Address - Country:US
Mailing Address - Phone:929-777-6139
Mailing Address - Fax:
Practice Address - Street 1:841 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4704
Practice Address - Country:US
Practice Address - Phone:646-502-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2022-06-13
Deactivation Date:2022-04-26
Deactivation Code:
Reactivation Date:2022-06-13
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY61779-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program