Provider Demographics
NPI:1366495699
Name:BASTIN, VALERIE ANN (DDS)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:BASTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-1802
Mailing Address - Country:US
Mailing Address - Phone:765-675-9400
Mailing Address - Fax:765-452-6264
Practice Address - Street 1:115 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1802
Practice Address - Country:US
Practice Address - Phone:765-675-9400
Practice Address - Fax:765-452-6264
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120094041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice