Organization
C. LEE BASS, III, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL LEE BASS III DDS (PRESIDENT/DENTIST)
(704) 873-3321
Entity
Organization
Contact information
Practice address
646 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625-4353
(704) 873-3321
Mailing address
646 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625-4353
(704) 873-3321
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6420
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
467563
UNITED CONCORDIA
NC
01
—
90511
BCBSNC
NC
Enumeration date
09/06/2006
Last updated
08/22/2020
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