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General NPI Number Information
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NPI Number | 1194034975
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Entity Type | Individual
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Provider Name | BASEL DANAN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 453 SUNCREST TOWN CENTER DR. WVU DENTAL CARE
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City | MORGANTOWN
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State | WV
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Zip | 26505
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Country | US
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Telephone | 304-293-5831
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Fax |
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Provider Business Mailing Address
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Address Line | 223 DONNA AVE
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City | MORGANTOWN
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State | WV
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Zip | 26505-3904
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Country | US
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Telephone | 714-399-8006
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 25407
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License Number State | TX
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