Provider Demographics
NPI:1770703241
Name:BASSHAM, DEBORAH A (DDS, MS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:BASSHAM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 NW MAYNARD RD # 1B
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8720
Mailing Address - Country:US
Mailing Address - Phone:919-466-0909
Mailing Address - Fax:
Practice Address - Street 1:1203 NW MAYNARD RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8720
Practice Address - Country:US
Practice Address - Phone:919-466-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics