Provider Demographics
NPI:1194034975
Name:DANAN, BASEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASEL
Middle Name:
Last Name:DANAN
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 1:223 DONNA AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3904
Mailing Address - Country:US
Mailing Address - Phone:714-399-8006
Mailing Address - Fax:
Practice Address - Street 1:453 SUNCREST TOWN CENTER DR.
Practice Address - Street 2:WVU DENTAL CARE
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-293-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics