1538224704 NPI number — TARANNUM BASHER D.M.D.

Table of content: TARANNUM BASHER D.M.D. (NPI 1538224704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538224704 NPI number — TARANNUM BASHER D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASHER
Provider First Name:
TARANNUM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538224704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 BROCKMAN MCCLIMON ROAD
Provider Second Line Business Mailing Address:
ASSOCIATE FAMILY HEALTH CENTER ATTN: DENTAL DEPARTMENT
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
846-989-1432
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 A REGENCY COMMONS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREER (GREER, SC)
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-275-5886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  012121 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: #3566 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)