Provider Demographics
NPI:1487885083
Name:BACHOURA, ALEX GHASSAN (DDS, MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:GHASSAN
Last Name:BACHOURA
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26321 NORTHWEST FWY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5758
Mailing Address - Country:US
Mailing Address - Phone:281-256-8400
Mailing Address - Fax:281-256-8412
Practice Address - Street 1:26321 NORTHWEST FWY
Practice Address - Street 2:SUITE 700
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5758
Practice Address - Country:US
Practice Address - Phone:281-256-8400
Practice Address - Fax:281-256-8412
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA51043122300000X
TX247871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist