Provider Demographics
NPI:1790394393
Name:ROBERT W BASSHAM DDS PA
Entity type:Organization
Organization Name:ROBERT W BASSHAM DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BASSHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-238-7570
Mailing Address - Street 1:669 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-1602
Mailing Address - Country:US
Mailing Address - Phone:870-238-7570
Mailing Address - Fax:870-238-1208
Practice Address - Street 1:669 ADDISON DR
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-1602
Practice Address - Country:US
Practice Address - Phone:870-238-7570
Practice Address - Fax:870-238-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty