Organization
BASISTA & ELDRIDGE DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN BASISTA DDS (PRESIDENT TREASURER)
(239) 936-3866
Entity
Organization
Contact information
Practice address
2454 WINKLER AVE, FORT MYERS, FL 33901
(239) 936-3866
(239) 939-5098
Mailing address
2454 WINKLER AVE, FORT MYERS, FL 33901
(239) 936-3866
(239) 939-5098
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
FL
Other
Enumeration date
11/14/2006
Last updated
08/22/2020
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