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General NPI Number Information
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NPI Number | 1518215474
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Entity Type | Individual
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Provider Name | BASILEE FRANCO GONZALEZ D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 3337 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3602
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Country | US
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Telephone | 773-481-2772
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Fax | 773-481-2742
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Provider Business Mailing Address
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Address Line | 3337 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3602
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Country | US
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Telephone | 773-481-2772
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Fax | 773-481-2742
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019027222
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License Number State | IL
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