Organization
TIMOTHY J. BASHARA, DMD, PLC
Active
Other names
Sweet Tooth Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J BASHARA DMD (OWNER, DENTIST)
(480) 988-1879
Entity
Organization
Contact information
Practice address
5656 S. POWER RD., STE. 118, GILBERT, AZ 85295
(480) 988-1879
(480) 988-4690
Mailing address
5656 S. POWER RD., STE. 118, GILBERT, AZ 85295
(480) 988-1879
(480) 988-4690
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D5688
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
718794
AHCCCS PROVIDER NUMBER
AZ
05
—
718794
—
AZ
Enumeration date
05/09/2007
Last updated
09/17/2008
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