Provider Demographics
NPI:1558561779
Name:KENNETH L BASEL DDS INC
Entity Type:Organization
Organization Name:KENNETH L BASEL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-842-5757
Mailing Address - Street 1:7029 PEARL RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-842-5757
Mailing Address - Fax:440-842-5795
Practice Address - Street 1:7029 PEARL RD
Practice Address - Street 2:SUITE 320
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-842-5757
Practice Address - Fax:440-842-5795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty