Provider Demographics
NPI:1770782039
Name:BASTIEN, RICHARD JEAN-PIERRE (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JEAN-PIERRE
Last Name:BASTIEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6599 LAKE PISGAH DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2086
Mailing Address - Country:US
Mailing Address - Phone:850-566-2972
Mailing Address - Fax:850-219-1527
Practice Address - Street 1:1433 PIEDMONT DR E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7943
Practice Address - Country:US
Practice Address - Phone:850-425-1300
Practice Address - Fax:850-219-1527
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177861223G0001X
FLDN-177861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice