Healthcare Provider Details

I. General information

NPI: 1851081012
Provider Name (Legal Business Name): SANJU BASI DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 08/19/2023
Certification Date: 08/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SUMMER ST
ROCKLAND ME
04841-2917
US

IV. Provider business mailing address

19 SUMMER ST
ROCKLAND ME
04841-2917
US

V. Phone/Fax

Practice location:
  • Phone: 207-594-8353
  • Fax:
Mailing address:
  • Phone: 207-594-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANJU BASI
Title or Position: DENTIST
Credential: DDS
Phone: 248-954-6840