Provider Demographics
NPI:1013778992
Name:BASTON, CODRINA ALEXANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:CODRINA
Middle Name:ALEXANDRA
Last Name:BASTON
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 1:26146 LONG ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6557
Mailing Address - Country:US
Mailing Address - Phone:760-805-4588
Mailing Address - Fax:
Practice Address - Street 1:15555 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3466
Practice Address - Country:US
Practice Address - Phone:760-244-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice