Active NPI
Johanna Rita Bassil, DMD
- Dentist
- Orange City, FL
National Provider Identifier
1235975871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 29296
- Practice address
- 2565 Enterprise Rd Ste 100
Orange City, FL 32763-8016 - Phone
- (386) 456-9101
- NPI assigned
- Jul 3, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 29296 | FL | Primary |
Addresses
Primary practice location
2565 Enterprise Rd Ste 100
Orange City, FL 32763-8016
Mailing address
5764 NW 56TH MNR
Coral Springs, FL 33067-3504
Phone (561) 901-3526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29296 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719964800000",
"number": "1235975871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5764 NW 56TH MNR",
"city": "CORAL SPRINGS",
"state": "FL",
"postal_code": "330673504",
"telephone_number": "561-901-3526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2565 ENTERPRISE RD STE 100",
"city": "ORANGE CITY",
"state": "FL",
"postal_code": "327638016",
"telephone_number": "386-456-9101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASSIL",
"first_name": "JOHANNA",
"middle_name": "RITA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-03",
"last_updated": "2024-07-03",
"certification_date": "2024-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "29296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.