Provider Demographics
NPI:1720009418
Name:BASSETT, JILL HAYES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:HAYES
Last Name:BASSETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 STONY SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5433
Mailing Address - Country:US
Mailing Address - Phone:502-499-6171
Mailing Address - Fax:502-499-9980
Practice Address - Street 1:3409 STONY SPRING CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5433
Practice Address - Country:US
Practice Address - Phone:502-499-6171
Practice Address - Fax:502-499-9980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611360702Medicare UPIN