Provider Demographics
NPI:1053675173
Name:BASSI, MEGHA (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGHA
Middle Name:
Last Name:BASSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 MENCHACA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2747
Mailing Address - Country:US
Mailing Address - Phone:512-428-5859
Mailing Address - Fax:
Practice Address - Street 1:11200 MENCHACA ROAD
Practice Address - Street 2:SUITE 4 BLD 4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-2042
Practice Address - Country:US
Practice Address - Phone:512-428-5859
Practice Address - Fax:512-428-5859
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280271223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310316001OtherTPI