Provider Demographics
NPI:1437296050
Name:HERBLY, BASEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASEL
Middle Name:
Last Name:HERBLY
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 1:2500 HARRIMAN LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4530
Mailing Address - Country:US
Mailing Address - Phone:323-828-6604
Mailing Address - Fax:
Practice Address - Street 1:2500 HARRIMAN LN
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4530
Practice Address - Country:US
Practice Address - Phone:323-828-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist