Provider Demographics
NPI:1891701009
Name:BASS, ROBERT LARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LARRY
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 1:72780 EL PASEO
Mailing Address - Street 2:SUITE E1
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3391
Mailing Address - Country:US
Mailing Address - Phone:760-346-7431
Mailing Address - Fax:760-341-6949
Practice Address - Street 1:72780 EL PASEO
Practice Address - Street 2:SUITE E1
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3391
Practice Address - Country:US
Practice Address - Phone:760-346-7431
Practice Address - Fax:760-341-6949
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery