Provider Demographics
NPI:1083677249
Name:BASSETT, PETER A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
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 1:9035 N 43RD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-3265
Mailing Address - Country:US
Mailing Address - Phone:623-435-2300
Mailing Address - Fax:623-435-7287
Practice Address - Street 1:9035 N 43RD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3265
Practice Address - Country:US
Practice Address - Phone:623-435-2300
Practice Address - Fax:623-435-7287
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery