Provider Demographics
NPI:1629470471
Name:BASSETT DENTISTRY LLC
Entity Type:Organization
Organization Name:BASSETT DENTISTRY LLC
Other - Org Name:SHOW ME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-756-1236
Mailing Address - Street 1:19 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2503
Mailing Address - Country:US
Mailing Address - Phone:573-756-1236
Mailing Address - Fax:573-756-7660
Practice Address - Street 1:19 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2503
Practice Address - Country:US
Practice Address - Phone:573-756-1236
Practice Address - Fax:573-756-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC11380061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty