Provider Demographics
NPI:1447400486
Name:BASSETT DENTAL SERVICES LLC
Entity Type:Organization
Organization Name:BASSETT DENTAL SERVICES LLC
Other - Org Name:BASSETT DENTAL SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROX CHATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-481-4825
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-0427
Mailing Address - Country:US
Mailing Address - Phone:334-289-9978
Mailing Address - Fax:334-289-6078
Practice Address - Street 1:901 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3327
Practice Address - Country:US
Practice Address - Phone:334-289-9978
Practice Address - Fax:334-289-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL92405OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL008804910Medicaid
AL851148OtherTRICARE