Provider Demographics
NPI:1407595150
Name:BASS, ALLISON (DMD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-1101
Mailing Address - Country:US
Mailing Address - Phone:803-279-9346
Mailing Address - Fax:803-279-9000
Practice Address - Street 1:540 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-1101
Practice Address - Country:US
Practice Address - Phone:803-279-9346
Practice Address - Fax:803-279-9000
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.101881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003853482OtherGROUP NPI