Provider Demographics
NPI:1245959444
Name:BASHANDY, NOOR (DDS)
Entity type:Individual
Prefix:DR
First Name:NOOR
Middle Name:
Last Name:BASHANDY
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 1:2754 CLARION PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6683
Mailing Address - Country:US
Mailing Address - Phone:925-914-9388
Mailing Address - Fax:
Practice Address - Street 1:1586 GATEWAY BLVD STE C1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6911
Practice Address - Country:US
Practice Address - Phone:707-426-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist