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General NPI Number Information
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NPI Number | 1285292342
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Entity Type | Individual
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Provider Name | GREIVY SANTANA BASTO DMD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 9840 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3912
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Country | US
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Telephone | 305-223-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 14097 NW 16TH DR
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-3010
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Country | US
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Telephone | 786-447-8841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 24149
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License Number State | FL
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