Provider Demographics
NPI:1588796452
Name:BASILICE, D.D.S, JOSEPH PARKMAN (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PARKMAN
Last Name:BASILICE, D.D.S
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 1:34 LUCILLE LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5810
Mailing Address - Country:US
Mailing Address - Phone:631-673-6723
Mailing Address - Fax:
Practice Address - Street 1:131 MACDOUGAL ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1076
Practice Address - Country:US
Practice Address - Phone:631-673-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0348441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice