1053675173 NPI number — DR. MEGHA BASSI DDS

Table of content: DR. MEGHA BASSI DDS (NPI 1053675173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053675173 NPI number — DR. MEGHA BASSI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASSI
Provider First Name:
MEGHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1053675173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11200 MENCHACA RD STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78748-2747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-428-5859
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11200 MENCHACA ROAD
Provider Second Line Business Practice Location Address:
SUITE 4 BLD 4
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78748-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-428-5859
Provider Business Practice Location Address Fax Number:
512-428-5859
Provider Enumeration Date:
07/03/2012

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: 1223G0001X , with the licence number:  28027 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 310316001 . This is a "TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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