Healthcare Provider Details

I. General information

NPI: 1083677249
Provider Name (Legal Business Name): PETER A BASSETT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9035 N 43RD AVE SUITE C
PHOENIX AZ
85051-3265
US

IV. Provider business mailing address

9035 N 43RD AVE SUITE C
PHOENIX AZ
85051-3265
US

V. Phone/Fax

Practice location:
  • Phone: 623-435-2300
  • Fax: 623-435-7287
Mailing address:
  • Phone: 623-435-2300
  • Fax: 623-435-7287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: