Provider Demographics
NPI:1285143560
Name:BASHA, JULIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:
Last Name:BASHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 COMMONWEALTH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3211
Mailing Address - Country:US
Mailing Address - Phone:617-652-6869
Mailing Address - Fax:
Practice Address - Street 1:661 BOSTON POST RD E
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3732
Practice Address - Country:US
Practice Address - Phone:508-485-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1857775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist