Provider Demographics
NPI:1346392297
Name:BASILE, JOHN A (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BASILE
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 1:125 E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15342-1710
Mailing Address - Country:US
Mailing Address - Phone:724-746-5222
Mailing Address - Fax:724-746-9174
Practice Address - Street 1:125 E PIKE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:PA
Practice Address - Zip Code:15342-1710
Practice Address - Country:US
Practice Address - Phone:724-746-5222
Practice Address - Fax:724-746-9174
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025877L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice