Provider Demographics
NPI:1912089830
Name:BASIAGO, CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:BASIAGO
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 1:5373 E VILLAGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1600
Mailing Address - Country:US
Mailing Address - Phone:562-429-5965
Mailing Address - Fax:562-429-7318
Practice Address - Street 1:5373 E VILLAGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1600
Practice Address - Country:US
Practice Address - Phone:562-429-5965
Practice Address - Fax:562-429-7318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0322681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice