Individual
JACOB BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(803) 341-2626
Mailing address
912 DUNBARTON DR, NORTH AUGUSTA, SC 29841-3209
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10776
SC
Other
Enumeration date
07/01/2024
Last updated
07/01/2024
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