Provider Demographics
NPI:1902999782
Name:BASIL, MARGARET BERG (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:BERG
Last Name:BASIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:BERG
Other - Last Name:BASIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PA
Mailing Address - Street 1:33911 US HIGHWAY 19 NORTH
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-781-2400
Mailing Address - Fax:727-781-5820
Practice Address - Street 1:33911 US HIGHWAY 19 NORTH
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-781-2400
Practice Address - Fax:727-781-5820
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00135961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice