Healthcare Provider Details

I. General information

NPI: 1124968755
Provider Name (Legal Business Name): AMRIT S BASI DMD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 W BEVERLY PL
TRACY CA
95376-3011
US

IV. Provider business mailing address

436 W BEVERLY PL
TRACY CA
95376-3011
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-6487
  • Fax: 209-835-2634
Mailing address:
  • Phone: 209-835-6487
  • Fax: 209-835-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AMRIT SINGH BASI
Title or Position: PRESIDENT
Credential: DMD
Phone: 925-872-3174