Individual
WILSON J. BASQUIAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDH
Contact information
Practice address
5607 NW 27TH AVE STE 2, MIAMI, FL 33142-2826
(305) 805-1700
(305) 805-1715
Mailing address
5607 NW 27TH AVE STE 1, MIAMI, FL 33142-2826
(305) 805-1700
(305) 805-1715
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH20849
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022136500
—
FL
Enumeration date
08/15/2017
Last updated
09/10/2024
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