MEDICARE: DR. MICHAEL E BASS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7106	NC

General Provider Information

NPI Number	:	1780612515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E BASS DDS

Provider Business Mailing Address
First Line	:	1031 W WILLIAMS ST
Second Line	:	SUITE 101
City	:	APEX
State	:	NC
Zip	:	27502-3955
Country	:	US
Telephone Number	:	919-362-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 W WILLIAMS ST
Second Line	:	SUITE 101
City	:	APEX
State	:	NC
Zip	:	27502-3955
Country	:	US
Telephone Number	:	919-362-6789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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