Provider Demographics
NPI:1184112229
Name:H. BRONSON BASSIR DDS INC
Entity type:Organization
Organization Name:H. BRONSON BASSIR DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:BRONSON
Authorized Official - Last Name:BASSIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-529-8391
Mailing Address - Street 1:675 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-496-5001
Mailing Address - Fax:888-285-5330
Practice Address - Street 1:675 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-496-5001
Practice Address - Fax:888-285-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty