Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 13215 | MA |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 1667 | NH |
NPI | 1083606412 |
---|---|
Provider Name | John B Bassett |
First Address | Salem, NH 03079-2892 |
Second Address | Salem, NH 03079-2892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00XR0062 | BLUE SHEILD OF MA (01) | MA |
1001667 | NORTHEAST DELTA DENTAL (01) | NH |
13328 | BLUE SHIELD OF ME (01) | ME |
142502 | UNITED CONCORDIA (01) | NH |
16309 | HARVARD PILGRIM (01) | MA |
4264019 | AETNA DENTAL (01) | NH |
6773217001 | CIGNA (01) | NH |
703466 | TUFTS MEDICAL (01) | MA |
8004012 | UNITED HEALTHCARE (01) | NH |
89192010 | (05) | NH |
H003874 | CHAMPUS (01) | NH |
T25622 | (02) | NH |