Provider Demographics
NPI:1700014354
Name:BASS, JAMIE LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:BASS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:SCHWANINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1620 RIVERS BND APT 407
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3066
Mailing Address - Country:US
Mailing Address - Phone:402-770-9119
Mailing Address - Fax:
Practice Address - Street 1:4001 N 168TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-3203
Practice Address - Country:US
Practice Address - Phone:402-330-5535
Practice Address - Fax:414-266-5677
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7030-151223P0221X
NE67661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700014354Medicaid