Provider Demographics
NPI:1043302151
Name:BASSIUR, JENNIFER PAIGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PAIGE
Last Name:BASSIUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 MAMIE DYER LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3400
Mailing Address - Country:US
Mailing Address - Phone:917-696-9325
Mailing Address - Fax:
Practice Address - Street 1:999 CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1205
Practice Address - Country:US
Practice Address - Phone:866-987-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051187122300000X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5791200001Medicare NSC
NYV08599Medicare UPIN
DF1251Medicare PIN