Healthcare Provider Details

I. General information

NPI: 1639854524
Provider Name (Legal Business Name): HALEIGH ANNE BASS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 E GARRISON BLVD STE A
GASTONIA NC
28054-5144
US

IV. Provider business mailing address

1367 E GARRISON BLVD STE A
GASTONIA NC
28054-5144
US

V. Phone/Fax

Practice location:
  • Phone: 704-864-8393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13226
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: