MEDICARE: DR. BRETT ALAN BASS DDS, PC

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	12009451	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	886257	OTHER	AK	UCCI PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952310138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT ALAN BASS DDS, PC

Provider Business Mailing Address
First Line	:	1317 MILL BAY RD
Second Line	:
City	:	KODIAK
State	:	AK
Zip	:	99615-6411
Country	:	US
Telephone Number	:	907-486-3291
Fax Number	:	907-486-3015

Provider Business Practice Location Address
First Line	:	1317 MILL BAY RD
Second Line	:
City	:	KODIAK
State	:	AK
Zip	:	99615-6411
Country	:	US
Telephone Number	:	907-486-3291
Fax Number	:	907-486-3015

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/09/2007

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