Provider Demographics
NPI:1659785731
Name:BASSETT, ELIZABETH PRESTON (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PRESTON
Last Name:BASSETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8527 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-1559
Mailing Address - Country:US
Mailing Address - Phone:423-842-1402
Mailing Address - Fax:
Practice Address - Street 1:8527 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-1559
Practice Address - Country:US
Practice Address - Phone:423-842-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN98781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice