Provider Demographics
NPI:1720208192
Name:BASS, ELLIOT H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:H
Last Name:BASS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-3123
Mailing Address - Country:US
Mailing Address - Phone:201-327-3816
Mailing Address - Fax:201-585-5032
Practice Address - Street 1:1355-15 STREET
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-585-8585
Practice Address - Fax:201-585-5032
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1010269001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice