Basic Information
| Provider Information | |||||||||
| NPI: | 1699176461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, HAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 SEMORAN BLVD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7729404251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 N CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334263315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613695533 | ||||||||
| FaxNumber: | 5614242926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 09/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS4935 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.