Provider Demographics
NPI:1750404265
Name:BASHA, DIA M (DDS)
Entity type:Individual
Prefix:DR
First Name:DIA
Middle Name:M
Last Name: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 1:2685 PLEASANT HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-5402
Mailing Address - Country:US
Mailing Address - Phone:925-945-7500
Mailing Address - Fax:925-945-7888
Practice Address - Street 1:2685 PLEASANT HILL RD
Practice Address - Street 2:SUITE # A
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2098
Practice Address - Country:US
Practice Address - Phone:925-945-7500
Practice Address - Fax:925-945-7888
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist