Provider Demographics
NPI:1518453059
Name:KRAIDI, BASMAN (DDS)
Entity Type:Individual
Prefix:
First Name:BASMAN
Middle Name:
Last Name:KRAIDI
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 1:2258 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6401
Mailing Address - Country:US
Mailing Address - Phone:619-277-2911
Mailing Address - Fax:
Practice Address - Street 1:7165 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-4764
Practice Address - Country:US
Practice Address - Phone:814-864-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0418181223G0001X
MI2901600407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice