Provider Demographics
NPI:1922258961
Name:DONALD C. BASSHAM D.D.S. P.S.
Entity Type:Organization
Organization Name:DONALD C. BASSHAM D.D.S. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BASSHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-526-7012
Mailing Address - Street 1:614 E ALDER ST
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2073
Mailing Address - Country:US
Mailing Address - Phone:509-526-7012
Mailing Address - Fax:509-526-7013
Practice Address - Street 1:614 E ALDER ST
Practice Address - Street 2:SUITE # 6
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2073
Practice Address - Country:US
Practice Address - Phone:509-526-7012
Practice Address - Fax:509-526-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000080301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5027610Medicaid
WA5057898Medicaid