Provider Demographics
NPI:1750678447
Name:BASSHAM, CLARK EDWARD, FIELD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:EDWARD, FIELD
Last Name:BASSHAM
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 1:6611 DEBARR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1706
Mailing Address - Country:US
Mailing Address - Phone:907-337-0404
Mailing Address - Fax:
Practice Address - Street 1:6611 DEBARR RD STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1706
Practice Address - Country:US
Practice Address - Phone:907-337-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist