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General NPI Number Information
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NPI Number | 1497944649
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Entity Type | Organization
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Legal Business Name | JAY M. BASS D.D.S. P.C.
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 200 E WASHINGTON ST
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-552-2551
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Fax | 540-961-9864
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Provider Business Mailing Address
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Address Line | 200 E WASHINGTON ST
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-552-2551
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Fax | 540-961-9864
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Authorized Official
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Title or Position | PRES
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Name | DR. JOHN KEITH ROBERTSON
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Credential | DDS
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Telephone | 540-552-2551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401005365
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License Number State | VA
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