Provider Demographics
NPI:1295996411
Name:BASS, JAY MARSHALL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:MARSHALL
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 1:200 WASHINGTON ST SE
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-4838
Mailing Address - Country:US
Mailing Address - Phone:540-552-2551
Mailing Address - Fax:540-961-9864
Practice Address - Street 1:200 WASHINGTON ST SE
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-4838
Practice Address - Country:US
Practice Address - Phone:540-552-2551
Practice Address - Fax:540-961-9864
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice