Provider Demographics
NPI:1720293947
Name:CAYASSO SR, BASSETTE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASSETTE
Middle Name:A
Last Name:CAYASSO SR
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 1:1839 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-5021
Mailing Address - Country:US
Mailing Address - Phone:323-757-1761
Mailing Address - Fax:
Practice Address - Street 1:1839 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-5021
Practice Address - Country:US
Practice Address - Phone:323-757-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB373951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice