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General NPI Number Information
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NPI Number | 1245355312
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Entity Type | Organization
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Legal Business Name | DAVID C BASTACKY DMD PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 516 N ROLLING RD SUITE 104
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City | BALTIMORE
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State | MD
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Zip | 21228-4140
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Country | US
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Telephone | 410-744-4222
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Fax | 410-744-2472
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Provider Business Mailing Address
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Address Line | 516 N ROLLING RD SUITE 104
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City | BALTIMORE
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State | MD
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Zip | 21228-4140
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Country | US
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Telephone | 410-744-4222
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Fax | 410-744-2472
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. DAVID BASTACKY
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Credential | DMD PA
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Telephone | 410-744-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10337
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License Number State | MD
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