Marie Jane Basco, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DN12863 Issued in FL

Practice address

2771 Monument Rd Ste 21
Jacksonville, FL 32225-3514

Phone

(904) 641-3732

Fax

(904) 641-0225

NPI assigned

Jul 24, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Marie Basco Van Vlerin Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1376565721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2771 MONUMENT RD STE 21",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322253514",
            "telephone_number": "904-641-3732",
            "fax_number": "904-641-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2771 MONUMENT RD STE 21",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322253514",
            "telephone_number": "904-641-3732",
            "fax_number": "904-641-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASCO",
        "first_name": "MARIE",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN12863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "VAN VLERIN",
            "middle_name": "BASCO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Anjanjyoti Baruah, OTR/L
• Christopher Barusya, MBCHB
• Lisa Basarab
• Christopher Basco
• Claire Solomon Basco, APRN
• Angella D Bascom, A.R.N.P.
• Nichole Bashara, RBT19-80867
• Riyaz Bashir, M.D.
• Saeed Bashir, MD
• Raja Bashiti, LMHC

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.