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General NPI Number Information
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NPI Number | 1003086174
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Entity Type | Organization
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Legal Business Name | A.T. BASSIRI, D.D.S., P.A.
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 1661 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3425
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Country | US
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Telephone | 910-485-2273
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Fax | 910-485-0772
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Provider Business Mailing Address
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Address Line | 1661 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3425
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Country | US
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Telephone | 910-485-2273
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Fax | 910-485-0772
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIRSTEN TOI INMAN
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Credential |
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Telephone | 910-425-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6315
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License Number State | NC
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