Healthcare Provider Details

I. General information

NPI: 1083606412
Provider Name (Legal Business Name): JOHN B BASSETT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 STILES RD SUITE 210
SALEM NH
03079-2892
US

IV. Provider business mailing address

32 STILES RD SUITE 210
SALEM NH
03079-2892
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-8630
  • Fax: 603-893-3697
Mailing address:
  • Phone: 603-893-8630
  • Fax: 603-893-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number1667
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number13215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: