Provider Demographics
NPI:1033448550
Name:BASUNBUL, GHADEER I (BDS)
Entity Type:Individual
Prefix:DR
First Name:GHADEER
Middle Name:I
Last Name:BASUNBUL
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E NEWTON ST
Mailing Address - Street 2:RM G-401
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-4705
Mailing Address - Fax:617-638-4713
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:RM G-401
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4705
Practice Address - Fax:617-638-4713
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL107591223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics