Provider Demographics
NPI:1114017886
Name:MUNTEAN, BASILE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASILE
Middle Name:
Last Name:MUNTEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 E LINCOLN AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1907
Mailing Address - Country:US
Mailing Address - Phone:714-637-5222
Mailing Address - Fax:
Practice Address - Street 1:1122 E LINCOLN AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1907
Practice Address - Country:US
Practice Address - Phone:714-637-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91786-01Medicaid