Provider Demographics
NPI:1588761175
Name:BASIL, ELZBIETA W (DMD)
Entity type:Individual
Prefix:DR
First Name:ELZBIETA
Middle Name:W
Last Name:BASIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MOUNTAIN FARMS RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1838
Mailing Address - Country:US
Mailing Address - Phone:860-561-2121
Mailing Address - Fax:
Practice Address - Street 1:10 N MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1941
Practice Address - Country:US
Practice Address - Phone:860-561-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0085101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice