Provider Demographics
NPI:1801916614
Name:BASSIL, MARWAN BASSIL (DMD)
Entity type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:BASSIL
Last Name:BASSIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 ROUTE 202/206
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1761
Mailing Address - Country:US
Mailing Address - Phone:908-722-6666
Mailing Address - Fax:908-722-6667
Practice Address - Street 1:676 ROUTE 202/206
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1761
Practice Address - Country:US
Practice Address - Phone:908-722-6666
Practice Address - Fax:908-722-6667
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 207511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ273514712OtherTAX ID