Provider Demographics
NPI:1912104399
Name:GEBRAEL, BASSEL (DDS)
Entity Type:Individual
Prefix:
First Name:BASSEL
Middle Name:
Last Name:GEBRAEL
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 1:1830 SOUTH OCEAN DRIVE
Mailing Address - Street 2:#4303
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7716
Mailing Address - Country:US
Mailing Address - Phone:954-815-8040
Mailing Address - Fax:954-456-2797
Practice Address - Street 1:3146B NORTHSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:305-294-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics