Provider Demographics
NPI:1568486934
Name:BASTA, SAEDA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SAEDA
Middle Name:
Last Name:BASTA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W SAN BERNARDINO RD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1516
Mailing Address - Country:US
Mailing Address - Phone:626-915-7711
Mailing Address - Fax:626-915-7722
Practice Address - Street 1:217 W SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1516
Practice Address - Country:US
Practice Address - Phone:626-915-7711
Practice Address - Fax:626-915-7722
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452611223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics