Provider Demographics
NPI:1881820447
Name:BASIL, ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:BASIL
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 1:3535 SOUTH BALL STREET
Mailing Address - Street 2:APT. 201
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202
Mailing Address - Country:US
Mailing Address - Phone:919-928-4314
Mailing Address - Fax:
Practice Address - Street 1:3535 S BALL ST
Practice Address - Street 2:APT. 201
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-4426
Practice Address - Country:US
Practice Address - Phone:919-928-4314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist