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General NPI Number Information
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NPI Number | 1043302151
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Entity Type | Individual
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Provider Name | JENNIFER PAIGE BASSIUR D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 999 CENTRAL AVE STE 103
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City | WOODMERE
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State | NY
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Zip | 11598-1205
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Country | US
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Telephone | 866-987-6673
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Fax |
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Provider Business Mailing Address
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Address Line | 1841 MAMIE DYER LN
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City | VIENNA
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State | VA
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Zip | 22182-3400
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Country | US
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Telephone | 917-696-9325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051187
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number | 051187
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License Number State | NY
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