Provider Demographics
NPI:1427480979
Name:BASA, MARIA KARLA (DDS)
Entity type:Individual
Prefix:
First Name:MARIA KARLA
Middle Name:
Last Name:BASA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KARLA
Other - Middle Name:A
Other - Last Name:BASA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1041 E YORBA LINDA BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3763
Mailing Address - Country:US
Mailing Address - Phone:714-528-8252
Mailing Address - Fax:
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3763
Practice Address - Country:US
Practice Address - Phone:714-528-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0584281223P0221X
CA1034571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry