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General NPI Number Information
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NPI Number | 1912104399
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Entity Type | Individual
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Provider Name | BASSEL GEBRAEL D.D.S
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3146B NORTHSIDE DRIVE
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City | KEY WEST
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State | FL
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Zip | 33040
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Country | US
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Telephone | 305-294-4661
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 SOUTH OCEAN DRIVE #4303
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7716
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Country | US
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Telephone | 954-815-8040
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Fax | 954-456-2797
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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 | DN15557
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License Number State | FL
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