Provider Demographics
NPI:1821332024
Name:TRENTON FAMILY DENTAL CARE - DR.VASUDHA BASAVA DDS LLC
Entity Type:Organization
Organization Name:TRENTON FAMILY DENTAL CARE - DR.VASUDHA BASAVA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VASUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-988-6316
Mailing Address - Street 1:122 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-1528
Practice Address - Country:US
Practice Address - Phone:513-988-6316
Practice Address - Fax:513-988-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300224521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty