Provider Demographics
NPI:1558946715
Name:AFFORDABLE DENTURES & IMPLANTS - SHOREWOOD II, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - SHOREWOOD II, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-730-1378
Mailing Address - Street 1:576 BROOKFOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-9706
Mailing Address - Country:US
Mailing Address - Phone:815-730-1378
Mailing Address - Fax:
Practice Address - Street 1:576 BROOKFOREST AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-9706
Practice Address - Country:US
Practice Address - Phone:815-730-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty