Individual
GWENDOLYN BASILICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1 SHAWS CV, NEW LONDON, CT 06320-4902
(860) 444-0498
Mailing address
54 GARDNER AVE, NEW LONDON, CT 06320-4313
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
002820
CT
Other
Enumeration date
10/12/2005
Last updated
07/08/2007
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