Healthcare Provider Details

I. General information

NPI: 1962391318
Provider Name (Legal Business Name): KIROLOS BASSILE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E PRATT ST
BALTIMORE MD
21202-3117
US

IV. Provider business mailing address

2682 CAMEL CT
MANCHESTER MD
21102-1872
US

V. Phone/Fax

Practice location:
  • Phone: 609-575-9114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18821
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: