Healthcare Provider Details

I. General information

NPI: 1477471944
Provider Name (Legal Business Name): MOHAMMED BASMAN BASMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 WALNUT GROVE RD STE 4
CORDOVA TN
38018-4262
US

IV. Provider business mailing address

8135 WALNUT GROVE RD STE 4
CORDOVA TN
38018-4262
US

V. Phone/Fax

Practice location:
  • Phone: 901-737-8981
  • Fax:
Mailing address:
  • Phone: 901-239-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13186
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: