Healthcare Provider Details

I. General information

NPI: 1508601873
Provider Name (Legal Business Name): AMER BASMAJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10705 BLACKLICK EASTERN RD STE 100
PICKERINGTON OH
43147-5200
US

IV. Provider business mailing address

3713 PENDENT LN
COLUMBUS OH
43207-3478
US

V. Phone/Fax

Practice location:
  • Phone: 614-382-4648
  • Fax:
Mailing address:
  • Phone: 614-717-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027716
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: