Provider Demographics
NPI:1699176461
Name:BASS, DAVID (MS, HAS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BASS
Suffix:
Gender:M
Credentials:MS, HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807
Mailing Address - Country:US
Mailing Address - Phone:772-940-4251
Mailing Address - Fax:
Practice Address - Street 1:801 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3315
Practice Address - Country:US
Practice Address - Phone:561-369-5533
Practice Address - Fax:561-424-2926
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4935237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist