Individual
LOURDES BASULTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.A
Contact information
Practice address
4410 W 16TH AVE STE 52, HIALEAH, FL 33012-7193
(305) 825-9899
(305) 825-9858
Mailing address
4410 W 16TH AVE STE 52, HIALEAH, FL 33012-7193
(305) 825-9899
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
DR134398
FL
Other
Enumeration date
03/04/2020
Last updated
03/04/2020
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