Provider Demographics
NPI:1942388301
Name:AL-BASHA, JIHAD EDDINE (DDS)
Entity Type:Individual
Prefix:MR
First Name:JIHAD
Middle Name:EDDINE
Last Name:AL-BASHA
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 1:1569 SLOAT BLVD
Mailing Address - Street 2:SUITE 332
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1253
Mailing Address - Country:US
Mailing Address - Phone:415-664-6622
Mailing Address - Fax:415-664-6670
Practice Address - Street 1:1569 SLOAT BLVD
Practice Address - Street 2:SUITE 332
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1253
Practice Address - Country:US
Practice Address - Phone:415-664-6622
Practice Address - Fax:415-664-6670
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice