Provider Demographics
NPI:1992824379
Name:JOSEPH P. BASLICE D.D.S.
Entity Type:Organization
Organization Name:JOSEPH P. BASLICE D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PARKMAN
Authorized Official - Last Name:BASILICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-673-6723
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:631-427-1931
Practice Address - Street 1:34 LUCILLE LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5810
Practice Address - Country:US
Practice Address - Phone:631-673-6723
Practice Address - Fax:631-427-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0348441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty