Healthcare Provider Details

I. General information

NPI: 1730449554
Provider Name (Legal Business Name): HODA IMENI BASSIRI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2012
Last Update Date: 06/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CREEDMOOR RD SUITE 103
RALEIGH NC
27613-3600
US

IV. Provider business mailing address

6400 CREEDMOOR RD SUITE 103
RALEIGH NC
27613-3600
US

V. Phone/Fax

Practice location:
  • Phone: 919-977-7480
  • Fax: 919-977-7481
Mailing address:
  • Phone: 919-977-7480
  • Fax: 919-977-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: