Provider Demographics
NPI:1316077654
Name:BASTIAN, ROBERT STUART (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STUART
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 1:13009 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030
Mailing Address - Country:US
Mailing Address - Phone:816-763-5566
Mailing Address - Fax:816-763-2395
Practice Address - Street 1:13009 WHITE AVE
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030
Practice Address - Country:US
Practice Address - Phone:816-763-5566
Practice Address - Fax:816-763-2395
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO013796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist