Provider Demographics
NPI:1174565220
Name:BASS, PAULETTE S (DDS)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:S
Last Name:BASS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 MILITARY ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6630
Mailing Address - Country:US
Mailing Address - Phone:810-987-3340
Mailing Address - Fax:810-987-5554
Practice Address - Street 1:2901 MILITARY ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6630
Practice Address - Country:US
Practice Address - Phone:810-987-3340
Practice Address - Fax:810-987-5554
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0158071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice