Provider Demographics
NPI:1235975871
Name:BASSIL, JOHANNA RITA (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:RITA
Last Name:BASSIL
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 1:5764 NW 56TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3504
Mailing Address - Country:US
Mailing Address - Phone:561-901-3526
Mailing Address - Fax:
Practice Address - Street 1:2565 ENTERPRISE RD STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8016
Practice Address - Country:US
Practice Address - Phone:386-456-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist