Provider Demographics
NPI:1285753574
Name:BASHARA, TIMOTHY J (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:BASHARA
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 1:5656 S. POWER RD.
Mailing Address - Street 2:STE. 118
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295
Mailing Address - Country:US
Mailing Address - Phone:480-988-1879
Mailing Address - Fax:480-988-4690
Practice Address - Street 1:5656 S. POWER RD.
Practice Address - Street 2:STE. 118
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-988-1879
Practice Address - Fax:480-988-4690
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD56881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ718794Medicaid
AZ718794Medicaid