Provider Demographics
NPI:1346791084
Name:JOSEPH BASILICATO DMD LLC
Entity Type:Organization
Organization Name:JOSEPH BASILICATO DMD LLC
Other - Org Name:SMILE CARE FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASILICATO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-831-0109
Mailing Address - Street 1:191 HAMBURG TPKE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2330
Mailing Address - Country:US
Mailing Address - Phone:973-831-0109
Mailing Address - Fax:973-831-6399
Practice Address - Street 1:191 HAMBURG TPKE
Practice Address - Street 2:SUITE 6
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2330
Practice Address - Country:US
Practice Address - Phone:973-831-0109
Practice Address - Fax:973-831-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty