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General NPI Number Information
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NPI Number | 1891240487
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Entity Type | Organization
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Legal Business Name | MICHAEL T. BASNETT DDSPC BASNETT FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 101 E 6TH ST
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City | FULTON
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State | MO
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Zip | 65251-1943
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Country | US
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Telephone | 573-642-1210
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Fax | 573-642-6139
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Provider Business Mailing Address
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Address Line | 101 E 6TH ST
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City | FULTON
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State | MO
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Zip | 65251-1943
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Country | US
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Telephone | 573-642-1210
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Fax | 573-642-6139
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Authorized Official
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Title or Position | DENTIST
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Name | MICHAEL T BASNETT
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Credential | DDS
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Telephone | 573-642-1210
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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 |
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License Number State | MO
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