Provider Demographics
NPI:1417165283
Name:BASTADJIAN, JOE (DDS)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BASTADJIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 38TH ST
Mailing Address - Street 2:APT 12 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 E 64TH ST
Practice Address - Street 2:SUITE # 403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6635
Practice Address - Country:US
Practice Address - Phone:212-832-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0467991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics