Provider Demographics
NPI:1649394230
Name:BASTIDAS FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:BASTIDAS FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASTIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-857-0222
Mailing Address - Street 1:904 POMPTON AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1262
Mailing Address - Country:US
Mailing Address - Phone:973-857-0222
Mailing Address - Fax:973-857-9508
Practice Address - Street 1:904 POMPTON AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1262
Practice Address - Country:US
Practice Address - Phone:973-857-0222
Practice Address - Fax:973-857-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty