Provider Demographics
NPI:1346396371
Name:BASSWOOD FAMILY DENTAL PA
Entity Type:Organization
Organization Name:BASSWOOD FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HARVEEN
Authorized Official - Middle Name:DHILLON
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-788-7700
Mailing Address - Street 1:5428 BASSWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137
Mailing Address - Country:US
Mailing Address - Phone:817-788-7700
Mailing Address - Fax:817-281-0055
Practice Address - Street 1:5428 BASSWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-788-7700
Practice Address - Fax:817-281-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty