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General NPI Number Information
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NPI Number | 1023399607
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Entity Type | Individual
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Provider Name | SABRINA LATRICE BASLEY R.D.H
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Gender | Female
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 7633 E JEFFERSON AVE STE 70
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City | DETROIT
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State | MI
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Zip | 48214-3730
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Country | US
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Telephone | 313-499-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 8630 N INKSTER RD APT 105
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-1066
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Country | US
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Telephone | 313-587-2873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902015255
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License Number State | MI
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