Individual
LEON BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
18622 AVON RD, JAMAICA, NY 11432-5823
(917) 892-3628
Mailing address
18622 AVON RD, JAMAICA, NY 11432-5823
(917) 892-3628
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
050924
NY
Other
Enumeration date
04/06/2007
Last updated
02/05/2014
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