Provider Demographics
NPI:1568990851
Name:BASSO, MAURICIO (DDS)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:BASSO
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:PO BOX 100436
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0436
Mailing Address - Country:US
Mailing Address - Phone:352-273-5440
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR RM D1-11
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1078
Practice Address - Country:US
Practice Address - Phone:352-273-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN274921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics