Provider Demographics
NPI:1083606412
Name:BASSETT, JOHN B (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:BASSETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STILES RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2892
Mailing Address - Country:US
Mailing Address - Phone:603-893-8630
Mailing Address - Fax:603-893-3697
Practice Address - Street 1:32 STILES RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2892
Practice Address - Country:US
Practice Address - Phone:603-893-8630
Practice Address - Fax:603-893-3697
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16671223P0106X
MA132151223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH6773217001OtherCIGNA
NH4264019OtherAETNA DENTAL
NH89192010Medicaid
NH1001667OtherNORTHEAST DELTA DENTAL
ME13328OtherBLUE SHIELD OF ME
MA703466OtherTUFTS MEDICAL
MA00XR0062OtherBLUE SHEILD OF MA
NH8004012OtherUNITED HEALTHCARE
NH142502OtherUNITED CONCORDIA
MA16309OtherHARVARD PILGRIM
NHH003874OtherCHAMPUS
NH8004012OtherUNITED HEALTHCARE
NHNH2010Medicare ID - Type Unspecified