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Individual

DR. ROBERT WALTON BASSHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
669 ADDISON DRIVE, WYNNE, AR 72396
(870) 238-7570
(870) 238-1208
Mailing address
669 ADDISON DRIVE, PO BOX 469, WYNNE, AR 72396
(870) 238-7570
(870) 238-1208

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2867
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
58190
AR BC BS
AR
01
872310
UNITED CONCORDIA
AR
Enumeration date
11/14/2006
Last updated
07/08/2007
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