Provider Demographics
NPI:1235425513
Name:BASIL, SHAUNA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:L
Last Name:BASIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGH ST
Mailing Address - Street 2:LOWER LEVEL SUITE
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1100
Mailing Address - Country:US
Mailing Address - Phone:561-573-5732
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:LOWER LEVEL SUITE
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1100
Practice Address - Country:US
Practice Address - Phone:561-573-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1855679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist