Provider Demographics
NPI:1386799484
Name:BASS, STEPHEN M (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:BASS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-3072
Mailing Address - Country:US
Mailing Address - Phone:615-790-6213
Mailing Address - Fax:615-790-8440
Practice Address - Street 1:1113 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-3072
Practice Address - Country:US
Practice Address - Phone:615-790-6213
Practice Address - Fax:615-790-8440
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice