Basic Information
| Provider Information | |||||||||
| NPI: | 1255537544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASHOUR BUNN | ||||||||
| FirstName: | NADIA | ||||||||
| MiddleName: | BASSAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 MARLBOROUGH ST | ||||||||
| Address2: | #2 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021161800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177808816 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1096 REVERE BEACH PKWY | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021501454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178890177 | ||||||||
| FaxNumber: | 6178890211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 20176 | MA | Y | Dental Providers | Dentist |
No ID Information.