Most Relevant Information
Provider Data
| NPI Number: | 1003020512 |
| Provider Name: | BASILISO PATERNO TIU DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 22DI01911700 |
Most Important Dates
| Enumeration Date: | 05/10/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
725 RIVER RD
SUITE 104 EDGEWATER PLAZA
EDGEWATER
NJ
07020
Practice Location Phone/Fax
| Phone: | 2019436644 |
| Fax: |
Provider Mailing Location
725 RIVER RD
SUITE 104 EDGEWATER PLAZA
EDGEWATER
NJ
07020
Provider Mailing Phone/Fax
| Phone: | 2019436644 |
| Fax: |