Provider Demographics
NPI:1023799632
Name:BASHOUR, MISHLEEN MAURICE (DDS)
Entity type:Individual
Prefix:DR
First Name:MISHLEEN
Middle Name:MAURICE
Last Name:BASHOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 N KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-3326
Mailing Address - Country:US
Mailing Address - Phone:484-951-2612
Mailing Address - Fax:
Practice Address - Street 1:750 N KROCKS RD STE 206
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9079
Practice Address - Country:US
Practice Address - Phone:610-530-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS044321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program