Healthcare Provider Details

I. General information

NPI: 1619130465
Provider Name (Legal Business Name): PETER A BASSETT, DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 623-435-2300
  • Fax: 623-435-1700
Mailing address:
  • Phone: 623-435-2300
  • Fax: 623-435-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number2176
License Number StateAZ

VIII. Authorized Official

Name: DR. PETER A BASSETT SR.
Title or Position: OWNER
Credential: DMD
Phone: 623-435-2300