Provider Demographics
NPI:1336139963
Name:BASSO, CHARLES U (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:U
Last Name:BASSO
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 1:457 E GRAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3353
Mailing Address - Country:US
Mailing Address - Phone:760-747-7878
Mailing Address - Fax:760-747-2156
Practice Address - Street 1:457 E GRAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3353
Practice Address - Country:US
Practice Address - Phone:760-747-7878
Practice Address - Fax:760-747-2156
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42640OtherSTATE LICENSE #