Provider Demographics
NPI:1386768059
Name:BASTIDAS, PATRICIA L (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:BASTIDAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 POMPTON AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1262
Mailing Address - Country:US
Mailing Address - Phone:973-857-0222
Mailing Address - Fax:973-857-9508
Practice Address - Street 1:904 POMPTON AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1262
Practice Address - Country:US
Practice Address - Phone:973-857-0222
Practice Address - Fax:973-857-9508
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI-018241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist