Provider Demographics
NPI:1518215474
Name:GONZALEZ, BASILEE FRANCO (DDS)
Entity Type:Individual
Prefix:
First Name:BASILEE
Middle Name:FRANCO
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3602
Mailing Address - Country:US
Mailing Address - Phone:773-481-2772
Mailing Address - Fax:773-481-2742
Practice Address - Street 1:3337 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3602
Practice Address - Country:US
Practice Address - Phone:773-481-2772
Practice Address - Fax:773-481-2742
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist