Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 203147 | CO |
N | 204E00000X | Oral & Maxillofacial Surgeon | DR60360447 | WA |
NPI | 1417299132 |
---|---|
Provider Name | Dr. Lauren Elizabeth Basile |
First Address | Englewood, CO 80113-3960 |
Second Address | Englewood, CO 80113-3960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 17/03/2018 |