NPIMap

Organization Active NPI

A.T. Bassiri, D.D.S., P.a.

Doing business as Pine Valley Family Dentistry

  • Dentist
  • Fayetteville, NC
National Provider Identifier
1003086174
Registry record updated Oct 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6315 Issued in NC
Legal business name
A.T. BASSIRI, D.D.S., P.A.
Doing business as
Pine Valley Family Dentistry
Practice address
1661 Owen Dr
Fayetteville, NC 28304-3425
Phone
(910) 485-2273
Fax
(910) 485-0772
NPI assigned
Mar 5, 2008
Last updated
Oct 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kirsten Toi Inman
Title
Office Manager
Phone
(910) 425-2273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 6315 NC Primary

Addresses

Primary practice location

1661 Owen Dr
Fayetteville, NC 28304-3425

Mailing address

1661 Owen Dr
Fayetteville, NC 28304-3425
Phone (910) 485-2273

Other identifiers 3

IdentifierTypeStateIssuer
767829OtherNCUNITED CONCORDIA
90477OtherNCBLUE CROSS OF NC
8990477MedicaidNC

Other names 1

  • Pine Valley Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
At Bassiri DDS PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1661 Owen Dr
Fayetteville, NC 28304
Phone (910) 485-2273

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414540800000",
    "number": "1003086174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043425",
            "telephone_number": "910-485-2273",
            "fax_number": "910-485-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043425",
            "telephone_number": "910-485-2273",
            "fax_number": "910-485-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A.T. BASSIRI, D.D.S., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-05",
        "last_updated": "2014-10-29",
        "status": "A",
        "authorized_official_last_name": "INMAN",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "TOI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "910-425-2273"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "6315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "767829",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF NC",
            "identifier": "90477",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8990477",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Valley Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.