Provider Demographics
NPI:1346451481
Name:BASIL, JOHN A
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BASIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1326
Mailing Address - Country:US
Mailing Address - Phone:304-737-3050
Mailing Address - Fax:304-737-3051
Practice Address - Street 1:1703 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1326
Practice Address - Country:US
Practice Address - Phone:304-737-3050
Practice Address - Fax:304-737-3051
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist