Provider Demographics
NPI:1811150535
Name:BRETT A. BASS, DDS PC
Entity type:Organization
Organization Name:BRETT A. BASS, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-486-3291
Mailing Address - Street 1:1317 MILL BAY RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6411
Mailing Address - Country:US
Mailing Address - Phone:907-486-3291
Mailing Address - Fax:907-486-3015
Practice Address - Street 1:1317 MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6411
Practice Address - Country:US
Practice Address - Phone:907-486-3291
Practice Address - Fax:907-486-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKD948261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK886257OtherUNITED CONCORDIA
AKDD02942Medicaid