Provider Demographics
NPI:1144499955
Name:S. BASSIRI DDS PA
Entity type:Organization
Organization Name:S. BASSIRI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-983-0095
Mailing Address - Street 1:642 S. MAIN ST.
Mailing Address - Street 2:P.O. BOX 1447
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021
Mailing Address - Country:US
Mailing Address - Phone:336-983-0095
Mailing Address - Fax:336-983-0588
Practice Address - Street 1:642 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9016
Practice Address - Country:US
Practice Address - Phone:336-983-0095
Practice Address - Fax:336-983-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902NUMedicaid