Provider Demographics
NPI:1881837193
Name:BASSIM, CAROL WALKER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:WALKER
Last Name:BASSIM
Suffix:
Gender:F
Credentials:DMD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CRC NIDCR NIH 10 CENTER DR
Mailing Address - Street 2:BLDG 10, RM 1N-118 MSC 1191
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-402-6822
Mailing Address - Fax:301-402-9885
Practice Address - Street 1:CRC NIDCR NIH 10 CENTER DR
Practice Address - Street 2:BLDG 10, RM 1N-118 MSC 1191
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-402-6822
Practice Address - Fax:301-402-9885
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist