Provider Demographics
NPI:1851081012
Name:SANJU BASI DDS PLLC
Entity type:Organization
Organization Name:SANJU BASI DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:BASI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-954-6840
Mailing Address - Street 1:19 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2917
Mailing Address - Country:US
Mailing Address - Phone:207-594-8353
Mailing Address - Fax:
Practice Address - Street 1:19 SUMMER ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2917
Practice Address - Country:US
Practice Address - Phone:207-594-8353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental