Provider Demographics
NPI:1710067772
Name:BASTIAN, HARRY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:B
Last Name:BASTIAN
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 1:3410 INDIAN SCHOOL RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1148
Mailing Address - Country:US
Mailing Address - Phone:505-265-6921
Mailing Address - Fax:505-268-5918
Practice Address - Street 1:3410 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1148
Practice Address - Country:US
Practice Address - Phone:505-265-6921
Practice Address - Fax:505-268-5918
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist