Provider Demographics
NPI:1376556969
Name:BASSETT, GARDNER G (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARDNER
Middle Name:G
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:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231
Mailing Address - Country:US
Mailing Address - Phone:716-204-5838
Mailing Address - Fax:716-632-2963
Practice Address - Street 1:2 CELLU DR
Practice Address - Street 2:STE 107
Practice Address - City:RASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063
Practice Address - Country:US
Practice Address - Phone:603-595-4200
Practice Address - Fax:603-689-7150
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist