Provider Demographics
NPI:1952317372
Name:BASHAR, SYED REHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:REHAN
Last Name:BASHAR
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 1:10004 204TH AVE E STE 2500
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6539
Mailing Address - Country:US
Mailing Address - Phone:253-447-8344
Mailing Address - Fax:253-447-8580
Practice Address - Street 1:10004 204TH AVE E STE 2500
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6539
Practice Address - Country:US
Practice Address - Phone:253-447-8344
Practice Address - Fax:253-447-8580
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist