Provider Demographics
NPI:1336281203
Name:PALLIS, BASIL N (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASIL
Middle Name:N
Last Name:PALLIS
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 1:485 RTE 517
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462
Mailing Address - Country:US
Mailing Address - Phone:973-827-7025
Mailing Address - Fax:
Practice Address - Street 1:2024 MACOPIN RD
Practice Address - Street 2:STE G
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1900
Practice Address - Country:US
Practice Address - Phone:973-728-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ162551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice