| NPI | 1700014354 |
|---|---|
| Former Name | JAMIE LYNN BASS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 6766) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 7030-15) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2026-01-29 |