Provider Demographics
NPI:1861546996
Name:BASSETT, ROSALYN PIERCE (DMD)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:PIERCE
Last Name:BASSETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3327
Mailing Address - Country:US
Mailing Address - Phone:334-289-9978
Mailing Address - Fax:334-289-6078
Practice Address - Street 1:901 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3327
Practice Address - Country:US
Practice Address - Phone:334-289-9978
Practice Address - Fax:334-289-6078
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL008804910Medicaid
AL92405OtherPROVIDER ID