Provider Demographics
NPI:1750338877
Name:DULLI, BASSEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BASSEL
Middle Name:
Last Name:DULLI
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 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9524
Mailing Address - Country:US
Mailing Address - Phone:630-418-0476
Mailing Address - Fax:815-717-8774
Practice Address - Street 1:1890 SILVER CROSS BLVD.
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:630-418-0476
Practice Address - Fax:815-717-8774
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0021061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry