Provider Demographics
NPI:1699773903
Name:BASNAR, CARY P (DDS)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:P
Last Name:BASNAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W DRAKE RD
Mailing Address - Street 2:BLDG. F, STE. B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5556
Mailing Address - Country:US
Mailing Address - Phone:970-419-4711
Mailing Address - Fax:970-419-4714
Practice Address - Street 1:702 W DRAKE RD
Practice Address - Street 2:BLDG. F, STE. B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5556
Practice Address - Country:US
Practice Address - Phone:970-419-4711
Practice Address - Fax:970-419-4714
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
CO1049581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice