MEDICARE: MARIA KARLA BASA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	058428	NY
2	1223P0221X	Pediatric Dentistry	103457	CA

General Provider Information

NPI Number	:	1427480979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA KARLA BASA DDS

Provider Business Mailing Address
First Line	:	1041 E YORBA LINDA BLVD STE 206
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3763
Country	:	US
Telephone Number	:	714-528-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 E YORBA LINDA BLVD STE 206
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3763
Country	:	US
Telephone Number	:	714-528-8252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	12/08/2021

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