Provider Demographics
NPI:1407959877
Name:BASKETT, BRUCE MARTIN (DMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:MARTIN
Last Name:BASKETT
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 107
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347
Mailing Address - Country:US
Mailing Address - Phone:270-298-7534
Mailing Address - Fax:
Practice Address - Street 1:10074 ST RT 54
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42378
Practice Address - Country:US
Practice Address - Phone:270-233-4551
Practice Address - Fax:270-233-4209
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5856208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice