1083606412 NPI number — JOHN B BASSETT DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083606412 NPI number — JOHN B BASSETT DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASSETT
Provider First Name:
JOHN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083606412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 STILES RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-2892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-893-8630
Provider Business Mailing Address Fax Number:
603-893-3697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 STILES RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03079-2892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-893-8630
Provider Business Practice Location Address Fax Number:
603-893-3697
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0106X , with the licence number:  1667 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0106X , with the licence number: 13215 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6773217001 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 4264019 . This is a "AETNA DENTAL" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 89192010 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001667 . This is a "NORTHEAST DELTA DENTAL" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 13328 . This is a "BLUE SHIELD OF ME" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 703466 . This is a "TUFTS MEDICAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00XR0062 . This is a "BLUE SHEILD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8004012 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 142502 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 16309 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: H003874 . This is a "CHAMPUS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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