Provider Demographics
NPI:1073127254
Name:BASSETT, NICOLETTE ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:ANNE
Last Name:BASSETT
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:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-0881
Mailing Address - Country:US
Mailing Address - Phone:231-620-8506
Mailing Address - Fax:
Practice Address - Street 1:10850 E TRAVERSE HWY STE 2250
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1319
Practice Address - Country:US
Practice Address - Phone:231-946-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist