MEDICARE: DR. MICHAEL BASS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5569	CT

General Provider Information

NPI Number	:	1497756902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BASS DMD

Provider Business Mailing Address
First Line	:	80 PHOENIX AVE
Second Line	:	SUITE #102
City	:	WATERBURY
State	:	CT
Zip	:	06702-1418
Country	:	US
Telephone Number	:	203-574-5524
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 PHOENIX AVE
Second Line	:	SUITE #102
City	:	WATERBURY
State	:	CT
Zip	:	06702-1418
Country	:	US
Telephone Number	:	203-574-5524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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