Provider Demographics
NPI:1932488871
Name:BASARAN, ISMAIL EMRAH (DDS)
Entity Type:Individual
Prefix:MR
First Name:ISMAIL
Middle Name:EMRAH
Last Name:BASARAN
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 1:3000 ALAMO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6345
Mailing Address - Country:US
Mailing Address - Phone:707-446-1777
Mailing Address - Fax:
Practice Address - Street 1:3000 ALAMO DR STE 103
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6345
Practice Address - Country:US
Practice Address - Phone:707-446-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice