Provider Demographics
NPI:1811559859
Name:BASHA, TAMARA (DMD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BASHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 BRIGHTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1053
Mailing Address - Country:US
Mailing Address - Phone:207-772-4359
Mailing Address - Fax:
Practice Address - Street 1:1036 BRIGHTON AVE STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1053
Practice Address - Country:US
Practice Address - Phone:207-772-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN51691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice