Provider Demographics
NPI:1013289925
Name:BASHA DENTAL GROUP PC
Entity type:Organization
Organization Name:BASHA DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-997-9999
Mailing Address - Street 1:1756 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1271
Mailing Address - Country:US
Mailing Address - Phone:586-997-9999
Mailing Address - Fax:
Practice Address - Street 1:1756 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1271
Practice Address - Country:US
Practice Address - Phone:586-997-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty