Provider Demographics
NPI:1316514003
Name:ABOZOR, BASEL M F
Entity type:Individual
Prefix:DR
First Name:BASEL
Middle Name:M F
Last Name:ABOZOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3504
Mailing Address - Country:US
Mailing Address - Phone:682-847-5874
Mailing Address - Fax:
Practice Address - Street 1:140 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3504
Practice Address - Country:US
Practice Address - Phone:682-847-5874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190345951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice