Individual
MR. ROGER KYLE BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
103 SOUTH FIR AVE., COLLINS, MS 39428
(601) 765-4355
(601) 765-4745
Mailing address
103 SOUTH FIR AVE., COLLINS, MS 39428
(601) 765-4355
(601) 765-4745
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3287
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02880272
—
MS
Enumeration date
10/30/2006
Last updated
07/09/2007
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