Provider Demographics
NPI:1730108580
Name:BASS, EUGENE HARVEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:HARVEY
Last Name:BASS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NEW HEMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1132
Mailing Address - Country:US
Mailing Address - Phone:845-362-1180
Mailing Address - Fax:845-362-4922
Practice Address - Street 1:500 NEW HEMPSTEAD RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1132
Practice Address - Country:US
Practice Address - Phone:845-362-1180
Practice Address - Fax:845-362-4922
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0388381223G0001X
NJ22D1015457001223G0001X
CA329461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice