Provider Demographics
NPI:1508601873
Name:BASMAJI, AMER
Entity type:Individual
Prefix:
First Name:AMER
Middle Name:
Last Name:BASMAJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 PENDENT LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3478
Mailing Address - Country:US
Mailing Address - Phone:614-717-5986
Mailing Address - Fax:
Practice Address - Street 1:10705 BLACKLICK EASTERN RD STE 100
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-5200
Practice Address - Country:US
Practice Address - Phone:614-382-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH30.027716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program