Provider Demographics
NPI:1144490483
Name:BASILIO, CAROL ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:BASILIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24022 CALLE DE LA PLATA
Mailing Address - Street 2:SUITE 450
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3626
Mailing Address - Country:US
Mailing Address - Phone:949-830-0074
Mailing Address - Fax:949-454-9419
Practice Address - Street 1:24022 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 450
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3626
Practice Address - Country:US
Practice Address - Phone:949-830-0074
Practice Address - Fax:949-454-9419
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist